Dieulafoy's lesion of duodenum: a case report

La lesión de Dieulafoy es una causa poco frecuente de sangrado digestivo, en especial de sangrado digestivo bajo. Consiste en la presencia de un vaso arterial de gran calibre en la submucosa del tracto digestivo, que en algún momento sufre erosión de la mucosa supra yacente y la pared vascular provocando hemorragia intermitente, potencialmente fatal. El caso que se describe es el primero de lesión de Dieulafoy localizada en el yeyuno reportado en la literatura médica hondureña e ilustra su presentación clínica y los hallazgos anatomopatológicos encontrados en la autopsia de un paciente masculino de 42 años que falleció por choque hipovolémico. El diagnóstico de la lesión de Dieulafoy es histopatológico y se hace en las resecciones quirúrgicas o la autopsia, sin embargo, sus características endoscópicas permiten diagnosticarla con alguna seguridad y tratarla, salvando la vida del paciente sin requerir otros procedimientos mayores. En el presente caso, el paciente no pudo ser sometido a endoscopia porque se mantuvo hemodinámicamente inestable, sin poderse tratar, ni determinar la región del sangrado para guiar al cirujano en la laparotomía. El objetivo de esta publicación es comunicar acerca de una causa poco frecuente de sangrado digestivo, que siempre debe considerarse en el diagnóstico clínico diferencial y los hallazgos encontrados en la autopsia, ya que estos no son reportados con frecuencia en la literatura.

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“…3. Un coágulo fresco adherido a un defecto mucoso mínimo o a la mucosa de aspecto normal 2, 5, 6,8,11,15 .…”

Section: Discussionunclassified

Lesión de Dieulafoy en el yeyuno. Presentación de caso y revisión de la literatura

López

Durón

2019

Rev. cienc. forenses Honduras

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“…Less than 50% of the lesions are identified during the initial endoscopic examination although repeated endoscopy will improve the diagnostic yield, especially when there is active bleeding 2 . The endoscopic criteria proposed to define Dieulafoy's lesion are 1) active arterial bleeding from a minute mucosal defect or through normal surrounding muscoa, 2) visualization of a protruding vessel with or without active bleeding within a minute mucosal defect or through normal surrounding mucosa, and 3) fresh densely adherent clot with a narrow point of attachment to a minute mucosal defect or to normal appearing mucosa 5 . Before urgent endoscopy was widely available, Dieulafoy's lesion was usually diagnosed by angiography or at surgery 6,7 .…”

Section: Discussionmentioning

confidence: 99%

Use of Sengstaken-Blakemore Tube to Stop Massive Upper Gastrointestinal Bleeding from Dieulafoy's Lesion in the Lower Oesophagus

2004

Anaesth Intensive Care

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Massive upper gastrointestinal bleeding from Dieulafoy's lesion in the gastrointestinal tract is uncommon. The use of the Sengstaken-Blakemore tube in acute gastrointestinal bleeding has become less common since endoscopic sclerotherapy and banding procedures have become widely available. The successful use of a Sengstaken-Blakemore tube to control acute massive upper gastrointestinal bleeding from a Dieulafoy's lesion in the lower oesophagus in an elderly man with severe coronary artery disease and heart failure is described.

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“…In recent years, more cases are diagnosed on first endoscopy, in some cases it remains undiagnosed till repeat endoscopy or until angiography is done. DL can be easily missed as awareness of pathology and careful endoscopy are key to accurate diagnosis [2]. Colonoscopy is usually indicated when endoscopy fails to find a cause of acute GI bleeding.…”

Section: Case Discussionmentioning

confidence: 99%

“…Surgical ligation is used in less than 5% case where endoscopy fails. Lastly, angiography and embolization are considered in patients where endoscopy and surgical approaches both fail [2]. We used hemoclipping for this patient.…”

Section: Case Discussionmentioning

confidence: 99%

An unusual Presentation of Dieulafoy’s Lesion as a Cause of Recurrent Lower Gastrointestinal/Rectal Bleeding: A Case Report

Malik¹,

Hussain²,

Naqvi³

2017

AJMCR

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Background: Dieulafoy lesion is a rare cause of acute gastrointestinal bleeding. It can present with sudden and massive bleeding without any prior symptoms. It causes massive hemorrhage leading to hemodynamic instability and this complicated nature of disease puts emphasis on its immediate diagnosis and treatment. Most commonly it presents with upper GIT bleeding but it can present with lower gastrointestinal bleeding. Case Presentation: We report a case of recurrent lower gastrointestinal bleeding that was miss diagnosed initially as internal hemorrhoids. A 91-year-old male was discharged 2 weeks ago, who presented again with rectal bleeding and low hemoglobin found on lab reports. He was admitted and transfused two packs of PRBC. After not finding any visible bleeding on upper endoscopy, he had colonoscopy and a bleeding vessel was found in rectum. Clipping was performed to stop bleeding and he was discharged home. Lower gastrointestinal bleeding is a very rare presentation of dieulafoy lesion. Conclusion: Dieulafoy lesion can present with upper or lower gastrointestinal bleeding. Diagnostic improvements and research for the detection of DL needs to be conducted to reduce hospital stay and improve survival. Endoscopic measures, mechanical banding, hemoclipping and electrocoagulation are some of the frequently used treatment options.

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Dieulafoy's lesion of duodenum: a case report

Abstract: Background: Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is rare. We report two cases of Dieulafoy's lesion of the duodenum and discuss the management of this extremely uncommon entity.

Cited by 22 publications

References 10 publications

Lesión de Dieulafoy en el yeyuno. Presentación de caso y revisión de la literatura

Lesión de Dieulafoy en el yeyuno. Presentación de caso y revisión de la literatura

Use of Sengstaken-Blakemore Tube to Stop Massive Upper Gastrointestinal Bleeding from Dieulafoy's Lesion in the Lower Oesophagus

An unusual Presentation of Dieulafoy’s Lesion as a Cause of Recurrent Lower Gastrointestinal/Rectal Bleeding: A Case Report

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