Dieulafoy's lesion - Wikipedia, the free encyclopedia

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Dieulafoy's lesion
From Wikipedia, the free encyclopedia

Dieulafoy's lesion (exulceratio simplex

Dieulafoy) is a medical condition
characterized by a large tortuous
arteriole in the stomach wall(sub
mucosal) that erodes and bleeds. It can

Dieulafoy's lesion

cause gastric hemorrhage[1] but is

relatively uncommon. It is 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: Leons 1-3" in 1898.[2][3] 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.

Blood supply of stomach

Classification and external resources
ICD-10

K25
(http://apps.who.int/classifications/icd10/browse/2015/en#/K25)

ICD-9-CM 537.84 (http://www.icd9data.com/getICD9Code.ashx?

icd9=537.84)

Contents

DiseasesDB 33135 (http://www.diseasesdatabase.com/ddb33135.htm)

1 Presentation
2 Symptoms
3 Treatment
4 Prognosis
5 References

Presentation
Dieulafoy's Lesions are characterized by a single large tortuous small artery[4] in the submucosa which does not
undergo normal branching or a branch with caliber of 15 mm (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 likely caused in the submucosal surface by protrusion
of the pulsatile arteriole.
Approximately 75% of Dieulafoy's lesions occur in the upper part of the stomach within 6 cm of the
gastroesophageal junction, most commonly in the lesser curvature. Extragastric lesions have historically been
thought to be uncommon but have been identified more frequently in recent years, likely due to increased
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awareness of the condition. The duodenum is the most common location (14%) followed by the colon (5%),
surgical anastamoses (5%), the jejunum (1%) and the esophagus (1%).[5] The pathology in these extragastric
locations is essentially the same as that of the more common gastric lesion.
In contrast to peptic ulcer disease, a history of alcohol abuse or NSAID use is usually absent in DL.
Dieulafoy's lesions occur twice as often in men as women and patients typically have multiple comorbidities,
including hypertension, cardiovascular disease, chronic kidney disease, and diabetes.

Symptoms
The symptoms due to bleeding are hematemesis and/or melena.[6]
Presenting Symptoms
Recurrent hematemesis with melena 51% of cases
Hematemesis without melena

28% of cases

Melena with no hematemesis

18% of cases

A Dieulafoy's lesion is difficult to diagnose, because of the intermittent pattern of bleeding. Endoscopically it is
not easy to recognize and therefore sometimes multiple views have to be performed over a longer period. Today
angiography is a good additional diagnostic, but then it can only be seen during a bleeding at that exact time.

Treatment
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 or monopolar
electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, hemoclipping or banding.
Alternatively, Interventional Radiology may be consulted for an angiogram with subselective embolization.

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

References
1. Akhras J, Patel P, Tobi M (March 2007). "Dieulafoy's lesion-like bleeding: an underrecognized cause of upper
gastrointestinal hemorrhage in patients with advanced liver disease". Dig. Dis. Sci. 52 (3): 7226. doi:10.1007/s10620006-9468-7 (https://dx.doi.org/10.1007%2Fs10620-006-9468-7). PMID 17237996
(https://www.ncbi.nlm.nih.gov/pubmed/17237996).
2. synd/3117 (http://www.whonamedit.com/synd.cfm/3117.html) at Who Named It?
3. G. Dieulafoy. Exulceratio simplex: Leons 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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4. Eidus, LB.; Rasuli, P.; Manion, D.; Heringer, R. (Nov 1990). "Caliber-persistent artery of the stomach (Dieulafoy's
vascular malformation).". Gastroenterology 99 (5): 150710. PMID 2210260
(https://www.ncbi.nlm.nih.gov/pubmed/2210260).
5. Lee Y, Walmsley R, Leong R, Sung J (2003). "Dieulafoy's Lesion". Gastrointestinal Endoscopy 58 (2): 236243.
doi:10.1067/mge.2003.328 (https://dx.doi.org/10.1067%2Fmge.2003.328). PMID 12872092
(https://www.ncbi.nlm.nih.gov/pubmed/12872092).
6. al-Mishlab, T; Amin, AM; Ellul, JP (August 1999). "Dieulafoy's lesion: an obscure cause of GI bleeding.". Journal of the
Royal College of Surgeons of Edinburgh 44 (4): 2225. PMID 10453143
(https://www.ncbi.nlm.nih.gov/pubmed/10453143).

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Categories: Stomach disorders
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