Esophageal Dieulafoy's lesion: an exceedingly rare cause of massive upper GI bleeding

Abstract

Dieulafoy's lesion, a dilated aberrant submucosal vessel which erodes the overlying epithelium, is a relatively rare but potentially fatal cause of gastrointestinal (Gl) bleeding. The esophagus is a very rare location for the lesion. Here we present a case of massive upper GI bleeding, secondary to this remarkably rare occurrence, which was amendable to endoscopic intervention.

Dieulafoy's lesion of the oesophagus: a case series and literature review

“…Delay in the diagnosis and inadequate management due to the lack of clinical familiarity make the Dieulafoy's lesion a stealth killer 5 25. Goldman review of 24 cases reported 19 deaths which give mortality as high as 80%, highlighting the urgent diagnosis and management of the lesion 26…”

Dieulafoy lesions and PHACE syndrome

“…It may be that this process is multifactorial, including disruption in the mucosal epithelium secondary to pulsations in the abnormally large submucosal vessel. Age, insults, and illness may also contribute, as DLs in adults have been correlated with comorbidities including cardiovascular disease, hypertension, chronic renal disease, diabetes mellitus, and excessive alcohol abuse . However, in most pediatric cases, including ours, these comorbidities are noncontributory.…”

Dieulafoy’s Lesion In The Oesophagus: A Rare Cause Of Upper Gastrointestinal Bleeding

“…The mortality rate has dropped from 80% to 8.6% since endoscopy has been employed in the identification of causes in GI bleeds, and it has been reported to be effective in more than 90% of patients. Endoscopy has 70% sensitivity, and if it fails to diagnose the lesion, angiography can be used to embolise the lesion 3. Giles et al reported TC-325 also known as Hemospray can be used as a rescue therapy when haemostasis cannot be achieved using standard interventions and as the first line in cases of diffuse bleeding that cannot be controlled using the latter.…”

“…Thirty-day rebleeding was significantly lower with Doppler-guided endoscopic haemostasis compared with standard visually guided haemostasis in patients with severe upper GI haemorrhage from ulcers or other lesions 20. If minimally invasive approaches fail, surgery is reserved as a last resort 3. Although a Dieulafoy’s lesion is exceedingly rare in the oesophagus, it is associated with a high mortality if undiscovered.…”

“…Its insidious onset, tendency to cause intermittent but severe bleeding and difficulty of endoscopic diagnosis has led to a very high mortality rate of up to 80% 2. In just over 100 years since Dieulafoy’s original case report, there have been about 280 published case reports in the literature, most commonly located in the lesser curvature of the stomach but rarely in the oesophagus 3. We aim to show a case of a 55-year-old man who presented with upper GI bleed caused by Dieulafoy’s lesion and to illustrate the significance of endoscopic therapy in these lesions.…”