Dieulafoy’s lesion and segmental dilatation of the small bowel: An uncommon cause of gastrointestinal bleeding

Morowitz, Michael J.; Markowitz, Richard I.; Kamath, Binita M.; Allmen, Daniel von

doi:10.1016/j.jpedsurg.2004.07.027

Cited by 31 publications

(35 citation statements)

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“…2 A Dieulafoy's lesion describes what is essentially a histologically normal vessel 3 that has an abnormally large diameter, maintaining a constant width of 1-3 mm. 2,3 It runs a tortuous course within the submucosa 3,8,12 and, typically, the lesion protrudes through a small mucosal defect varying from 2-5 mm, 3 which has fibrinoid necrosis at its base.…”

Section: Pathologymentioning

confidence: 99%

“…2,13 The mucosal defect occurs most commonly on the lesser curve 3,8,11,14,15 with 80% 7 to 95% 15 of these lesions being located within 6 cm of the gastro-oesophageal junction. 8,14,17 This is attributed to the architecture of the blood supply to the lesser curve of the stomach as the vessels arise directly from the arterial chain running outwith the lesser curve.…”

Section: Pathologymentioning

confidence: 99%

“…3,8,10,19 There are cases in the literature of newborns being affected, 5 while rare, this could support the suggestion that these lesions are in fact congenital in nature. 2,5,8,12 Interestingly, it has been observed from case histories that a large proportion of patients presenting with rupture are already hospitalised. This has led to the suggestion of stress injury and predilection for the infirm.…”

Section: Aetiologymentioning

confidence: 99%

“…4,5,23,24 Endoscopic haemostatic procedures can be classified into three groups: (i) thermal -electrocoagulation, heat probe coagulation and argon plasma coagulation; (ii) regional injection -local epinephrine injection and sclerotherapy; and (iii) mechanical -banding and haemoclip. 2,4,11,15,33 Each technique has both advantages and disadvantages related to the haemostatic mechanism and the technical procedure itself with varying success rates. 4 There is some evidence in the literature to suggest that endoscopic mechanical haemostatic methods are more effective and successful in achieving haemostasis when compared to injection or thermal treatment methods.…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

“…Dieulafoy's lesion is one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. 2,3 A Dieulafoy's lesion, also termed 'calibre persistent artery', 2 is a relatively rare, but potentially life-threatening, cause of haemorrhage from the gastrointestinal tract. It is difficult to determine its true incidence in the general population accurately as they are silent until presentation and, even then, it can pose a diagnostic challenge.…”

mentioning

confidence: 99%

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Dieulafoy's lesion: current trends in diagnosis and management

Baxter

Aly

2010

annals

298

372

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Ann R Coll Surg Engl 2010; 92: 548-554 548The incidence of acute gastrointestinal bleeding ranges from 50-150 per 100,000 of the population each year. It is caused by peptic ulcers and oesophageal or gastroduodenal erosions in almost 80% of patients.1 Obscure gastrointestinal bleeding is reported to account for up to 5% of all gastrointestinal (GI) haemorrhages. It is defined as overt or occult bleeding from a source that cannot be readily determined by standard investigations, such as barium studies and endoscopic investigation. The source is often difficult to locate because the pathology is anatomically inaccessible, small, or subtle. Dieulafoy's lesion is one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. 2,3A Dieulafoy's lesion, also termed 'calibre persistent artery', 2 is a relatively rare, but potentially life-threatening, cause of haemorrhage from the gastrointestinal tract. It is difficult to determine its true incidence in the general population accurately as they are silent until presentation and, even then, it can pose a diagnostic challenge. They are believed to account for only 1-2% of acute GI bleeding, [3][4][5] but are arguably under-recognised rather than being truly rare. The lack of awareness about the Dieulafoy's lesion contributes to its 'rarity', increase in morbidity, and also the previously reported mortality of up to 80% associated with this lesion.6 Rare or not, the precarious nature of the presentation make it necessary to include them in differential diagnosis of any acute GI haemorrhage. The aim of this article is to present an up-to-date review of literature on Dieulafoy's lesion and the recent trends in its diagnosis, treatment and prognosis. Materials and MethodsUsing Medline, a literature search was performed for papers published in English, using the text words 'Dieulafoy'(s)' and 'gastrointestinal bleeding'. All retrieved papers which were relevant to the study were analysed and the findings are summarised in this review. Overall, 159 Dieulafoy's lesion: current trends in diagnosis and management M Baxter, EH AlyLaparoscopic Colorectal Surgery and Training Unit, Aberdeen Royal Infirmary, Aberdeen, UK ABSTRACT BACKGROUND Dieulafoy's lesion is a relatively rare, but potentially life-threatening, condition. It accounts for 1-2% of acute gastrointestinal (GI) bleeding, but arguably is under-recognised rather than rare. Its serious nature makes it necessary to include it in the differential diagnosis of obscure GI bleeding. The aim of this study was to review the current trends in the diagnosis and management of Dieulafoy's lesion. MATERIALS AND METHODS Using Medline, a literature search was performed for articles published in English, using the search words 'Dieulafoy'(s)' and 'gastrointestinal bleeding'. All retrieved papers were analysed and the findings are summarised in this review. RESULTS There is no consensus on the treatment of Dieulafoy's lesions. Therapeutic endoscopy can control t...

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