Dieulafoy’s lesion: Rare cause of massive upper gastrointestinal bleeding

Abstract

Dieulafoy's lesion is an unusual and potentially life-threatening cause of massive, recurrent gastrointestinal bleeding. Its reported incidence as a source of upper gastrointestinal bleeding ranges from 0.3-6.7%. Dieulafoy's lesion is most commonly located in the proximal stomach (75% of cases). Lesion typically occur within 6 to 10 cm of the esophagogastric junction, generally along the lesser curvature of the stomach. Similar lesions have been identified in the esophagus, duodenal bulb, jejunum, ileum, colorectum, anal canal, even in bronchus. Detection and identification of the Dieulafoy's lesion as the source of bleeding can often be difficult, especially because most present with massive bleeding. Because of intermittent nature of bleeding, initial endoscopy is diagnostic in 60% of the cases, so repeated endoscopies are often necessary. If the lesion can be endoscopically documented, attempts should be made to achieve hemostasis using one or a combination of several endoscopic modalities. Success has been reported with multipolar electrocoagulation, heater probe, noncontact laser photocoagulation, injection sclerotherapy, endoscopic hemoclipping and band ligation. Surgery is reserved for lesions that cannot be controlled by endoscopic techniques. When localized, a wide wedge resection of entire area traversed by the large submucosal artery is recomended because rebleeding has been described after simple coagulation and ligation.

Upper digestive hemorrhage secondary to major duodenal papilla Dieulafoy’s lesion: Case report

“…The active bleeding during procedure was an important key to elucidate the lesion's nature. As a matter of fact, to diagnose a Dieulafoy's Lesion may be challenging even to an experienced endoscopist (Stojakov et al, 2007;Nojkov & Cappell, 2015). Previous studies demonstrated that even 49% of DL were identified on initial endoscopy and 33% of the patients required a repeted endoscopy (Reilly & Al-Kawas, 1991).…”

Use of Over-the-Scope Clip as First Choice to Treat Gastric Dieulafoy Lesions

“… 1 , 2 This lesion, which is frequently observed on the lesser curve of the stomach, is responsible for 0.3-6.7% of upper gastrointestinal hemorrhages. 3 It is more frequent in middle and older ages and more common in men. Endoscopic methods took place of surgery for treatment because of a high success rate.…”

Rare and Emergency Gastric Bleeding Cause – Dieulafoy's Lesion

“…This medical condition usually presents with a large tortuous arteriole in the stomach wall that erodes and bleeds. In addition, this lesion is generally located at the lesser curvature of the stomach within 6 to 10 cm of the esophagogastric junction (Stojakov et al, 2007). It consists of a single large tortuous arteriole that does not exert normal branching or has a branch 1-5 mm in diameter (Fig 2 & 3).…”