Dieulafoy’s lesion is an uncommon vascular abnormality characterized by a large-caliber, tortuous submucosal arteriole that fails to taper as it approaches the mucosal surface. This anomaly can lead to sudden and severe upper gastrointestinal bleeding despite the absence of a visible ulcer or mucosal defect. Although it accounts for less than 2% of cases of acute gastrointestinal hemorrhage, it remains a potentially life-threatening condition. The stomach, particularly the proximal lesser curvature, is the most frequent location; however, esophageal involvement is extremely rare, making careful endoscopic assessment essential when the bleeding source is not immediately evident.

We present the case of a 79-year-old man who arrived at the emergency department with presyncope, generalized weakness, mucocutaneous pallor, melena, and coffee-ground vomiting. Initial laboratory tests demonstrated a hemoglobin level of 6 g/dL, requiring transfusion and urgent endoscopic evaluation. During gastroscopy, a small red clot was identified in the distal esophagus, approximately 3 cm above the cardia. When gently displaced with the endoscope, brisk pulsatile bleeding was observed without an evident underlying mucosal injury, suggesting a Dieulafoy’s lesion (Forrest I). Immediate endoscopic therapy was performed using elastic band ligation, achieving complete hemostasis with no further bleeding events. The patient remained clinically stable with no recurrence during follow-up.

Esophageal Dieulafoy’s lesions pose significant diagnostic challenges due to their subtle appearance and uncommon location. Awareness of this entity is crucial, since failure to recognize it may delay treatment and worsen outcomes. Endoscopic therapy is considered first-line management, with band ligation and hemostatic clips demonstrating high success rates. Given the possibility of rebleeding, close monitoring and follow-up are recommended. This case highlights the importance of maintaining a high index of suspicion for Dieulafoy’s lesions in patients with severe upper gastrointestinal bleeding and emphasizes the effectiveness of early endoscopic intervention in ensuring hemostasis and preventing complications.