Dieulafoy's lesion
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
| Dieulafoy's lesion | |
| ICD-10 | K25 |
|---|---|
| ICD-9 | 537.84 |
| DiseasesDB | 33135 |
Overview
Dieulafoy's lesion is an uncommon cause of gastric bleeding thought to cause less than 5% of all gastrointestinal bleeds in adults. It was named after French surgeon Paul Georges Dieulafoy, who described this condition in his paper "Exulceratio simplex: Leçons 1-3" in 1898.[1][2] It is also called "Caliber-persistent artery" or "Aneurysm" of gastric vessels. However unlike most other aneurysms these are thought to be developmental malformations rather than degenerative changes.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Dieulafoy's lesion from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
The mortality rate for Dieulafoy's was much higher before the era of endoscopy, where open surgery was the only treatment option.
Diagnosis
Diagnostic Criteria
History and Symptoms
The symptoms due to bleeding are hematemesis and/or melena, possibly with shock.
Physical Examination
Dieulafoy's Lesions is characterized by a single large tortuous arteriole in the submucosa which does not undergo normal branching, or one of the branches retain high calibre of about 1-5 mm which is more than 10 times the normal diameter of mucosal capillaries. The lesion bleeds into the gastrointestinal tract through a minute defect in the mucosa which is not a primary ulcer of the mucosa but an erosion probably caused from the submucosal surface by the pulsatile arteriole protruding into the mucosa.
95% of Dieulafoy's lesions occur in the upper part of the stomach, within 6 cm of the gastroesophageal junction commonly in the lesser curvature, however they can occur anywhere in the GI tract.
Interestingly and in contrast to peptic ulcer disease, a history of alcohol abuse or NSAID use is usually absent in Dieulafoy's.
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
It is diagnosed and treated endoscopically, however endoscopic ultrasound or angiography can be of benefit.
Endoscopic techniques used in the treatment include epinephrine injection followed by bipolar electrocoagulation, monopolar electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, hemoclipping or banding.
Surgery
Prevention
References
- ↑ Template:WhoNamedIt
- ↑ G. Dieulafoy. Exulceratio simplex: Leçons 1-3. In: G. Dieulafoy, editor: Clinique medicale de l'Hotel Dieu de Paris. Paris, Masson et Cie: 1898:1-38.