Dieulafoy's lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Dieulafoy's lesion
ICD-10 K25
ICD-9 537.84
DiseasesDB 33135

Overview

Dieulafoy's lesion is an uncommon cause of gastric bleeding thought to cause less than 5% of all gastrointestinal bleeds in adults. It was named after French surgeon Paul Georges Dieulafoy, who described this condition in his paper "Exulceratio simplex: Leçons 1-3" in 1898.[1][2] It is also called "Caliber-persistent artery" or "Aneurysm" of gastric vessels. However unlike most other aneurysms these are thought to be developmental malformations rather than degenerative changes.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Dieulafoy's lesion from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

The mortality rate for Dieulafoy's was much higher before the era of endoscopy, where open surgery was the only treatment option.

Diagnosis

Diagnostic Criteria

History and Symptoms

The symptoms due to bleeding are hematemesis and/or melena, possibly with shock.

Physical Examination

Dieulafoy's Lesions is characterized by a single large tortuous arteriole in the submucosa which does not undergo normal branching, or one of the branches retain high calibre of about 1-5 mm which is more than 10 times the normal diameter of mucosal capillaries. The lesion bleeds into the gastrointestinal tract through a minute defect in the mucosa which is not a primary ulcer of the mucosa but an erosion probably caused from the submucosal surface by the pulsatile arteriole protruding into the mucosa.

95% of Dieulafoy's lesions occur in the upper part of the stomach, within 6 cm of the gastroesophageal junction commonly in the lesser curvature, however they can occur anywhere in the GI tract.

Interestingly and in contrast to peptic ulcer disease, a history of alcohol abuse or NSAID use is usually absent in Dieulafoy's.

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

It is diagnosed and treated endoscopically, however endoscopic ultrasound or angiography can be of benefit.

Endoscopic techniques used in the treatment include epinephrine injection followed by bipolar electrocoagulation, monopolar electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, hemoclipping or banding.

Surgery

Prevention

References

  1. synd/3117 at Who Named It
  2. G. Dieulafoy. Exulceratio simplex: Leçons 1-3. In: G. Dieulafoy, editor: Clinique medicale de l'Hotel Dieu de Paris. Paris, Masson et Cie: 1898:1-38.



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