Dieulafoy lesion
Thursday 10 July 2008, Branislav Kunčak, M. D. and Rudolf Králik, M.D.
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Dieulafoy lesion
- is a vascular abnormality, that can be a cause of massive gastrointestinal bleeding
- first described by French surgeon Dieulafoy in 1898 as exulceratio simplex
- the bleeding lesion is an abnormally large, superficial localized (in the muscularis mucosa) eroded artery which is not associated with inflammation or atherosclerosis
- the etiology is not known
- it is usually localized in the cardia or upper part of the stomach
- diagnosis of the lesion is based on endoscopic criteria: 1. active spurting or oozing bleeding from a minute (less than 3mm) mucosal defect or from normal surrounding mucosa 2. protruding vessel within a minute mucosal defect or normal surrounding mucosa 3. adherent clot with a narrow point of normal-appearing mucosa
- endoscopic therapies are now the first option in the management of Dieulafoy´s lesion
- mechanical endoscopic therapies (hemoclipping and endoscopic band ligation) appears to be more succesful than epinephrine injection in achieving permanent hemostasis
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Bigger image, Endoscopy
Fig. 1
Arterial bleeding from Dieulafoy´s lesion in the subcardial region of gastric body.
Bigger image, Endoscopy
Fig. 5
Dieulafoy lesion (protriding vessel within a minute mucosal defect) along the lesser curve in the upper part of gastric body. Finding in a patient examined for acute upper GI bleeding.
