Clinical characteristics of Dieulafoy’s lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Nakamura, Masanao; Yamamura, Takeshi; Maeda, Keiko; Sawada, Tsunaki; Ishikawa, Eri; Furukawa, Kazuhiro; Iida, Tadashi; Mizutani, Yasuyuki; Yamao, Kentaro; Ishikawa, Takuya; Honda, Takashi; Ishigami, Masatoshi; Kawashima, Hiroki

doi:10.1186/s12876-023-02913-1

Cited by 2 publications

(1 citation statement)

References 39 publications

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“…The presence of a DL in our patient meant that they were susceptible to sudden and massive bleeding, which could have been catastrophic without prompt endoscopic intervention. Had this lesion not been diagnosed and treated specifically, our patient might have been at risk for more severe outcomes, emphasizing the importance of actively searching for these lesions during endoscopic evaluations, especially in patients with a high comorbidity index [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities

Alfroukh,

Janajri,

Mikkawi

et al. 2023

Cureus

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Dieulafoy lesions (DL) consist of tortuous, thick-walled submucosal arteries that protrude through a small mucosal defect, often surrounded by otherwise normal mucosa. They are commonly located in the proximal stomach, particularly along the lesser curvature and near the esophagogastric junction, typically within 5 cm. However, they can also occur in various other regions of the GI tract, including the esophagus, duodenum, and colon. We present the case of a 76-year-old female with a complex medical history who arrived at the ED with hematemesis and melena. Her condition rapidly deteriorated; her blood pressure significantly dropped. Upon stabilization, upper endoscopy uncovered a 5-cm red lesion near the gastroesophageal junction, indicative of DL. Immediate intervention with clips was successful. Following the procedure, while the patient was in the ICU, she started to experience left-sided chest pain and diaphoresis, leading to the suspicion of acute coronary syndrome. Further investigations revealed non-ST-elevation myocardial infarction (NSTEMI). This case highlights the life-threatening nature of upper GI bleeding, especially in elderly patients with multiple comorbidities and extensive medication regimens. Timely diagnosis and intervention for DL are crucial, particularly in elderly patients with multiple health comorbidities. This underscores the significance of prompt medical attention and intervention in such complex scenarios.

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Section: Discussionmentioning

confidence: 99%

Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities

Alfroukh,

Janajri,

Mikkawi

et al. 2023

Cureus

View full text Add to dashboard Cite

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Duodenal Dieulafoy lesion: a rare and fatal cause of gastrointestinal bleeding

Shumilina,

Patricia,

Kochmar

2024

USMYJ

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the article summarizes the issue of Dielafoy lesion of the duodenum, as an unusual and rare cause of recurrent gastrointestinal bleeding, which can be fatal. This lesion can occur in various parts of the gastrointestinal tract (GI), most often in the stomach, especially at the level of the lesser curvature; however, it can occur in other parts, including the colon, esophagus, and duodenum. The main goal of this study is to improve the results of diagnosis and treatment of Dielafoy lesions by identifying the nuances of its clinical course and analyzing the use of various types of endoscopic hemostasis in patients with this syndrome. The research used the methods of bibliographic and content analysis of the literature, comparative approach and synthesis, as well as semantic grouping in relation to the features of the course, diagnosis and treatment of the Dielafoy lesion of the duodenum. All documents found on various official websites were analyzed and the collected information was compared and grouped. The relevance of the study is that gastrointestinal bleeding is one of the main problems and causes of mortality in emergency surgery. In the etiology of gastrointestinal bleeding, a number of well-known pathologies are distinguished, such as peptic ulcer disease of the stomach and duodenum, Mallory-Weiss syndrome, neoplasms and varicose veins of the esophagus and stomach. There are also a number of other, rare, but no less dangerous diseases characterized by the development of acute gastroduodenal bleeding. They include Dielafoy lesion - a rare genetic pathology characterized by the abnormal development of blood vessels in the submucosal layer without signs of an inflammatory process, which rupture causes profuse bleeding. Despite the expansion of diagnostic and therapeutic possibilities, the risk of bleeding and its danger for life in the case of damage to the DL is still quite high. Clinical manifestations include painless upper gastrointestinal bleeding, including melena, hematochezia and vomiting or rarely iron deficiency anemia (IDA); however, most patients are asymptomatic. Some patients also have non-gastrointestinal comorbidities such as hypertension, diabetes, and chronic kidney disease (CKD). The diagnosis is made by esophagogastroduodenoscopy (EGD), which includes the presence of micropulsatile jets from the mucosal defect, the appearance of a fresh, densely adherent clot with a narrow point of attachment to a small mucosal defect, and visualization of a protruding vessel with or without bleeding. Initial FGDS may be nondiagnostic due to the relatively small size of the lesion. Other diagnostic methods include endoscopic ultrasound and mesenteric angiography. Treatment of duodenal DL includes thermoelectrocoagulation, local injection of epinephrine, sclerotherapy, bandaging and hemoclips. We present here the case of a 71-year-old woman with a history of severe IBD requiring multiple blood transfusions and intravenous iron and who was found to have a Duodenal Dealfoy lesion. The results of this study may be of interest to primary care physicians, therapists, gastroenterologists, laboratory diagnosticians, endoscopists and surgeons.

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Clinical characteristics of Dieulafoy’s lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Cited by 2 publications

References 39 publications

Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities

Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities

Duodenal Dieulafoy lesion: a rare and fatal cause of gastrointestinal bleeding

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