Dieulafoy's lesion

A rare but potentially life-threatening condition involving a small, abnormally large artery in the gastrointestinal tract.

Dieulafoy's lesion

Diagram of the stomach showing the location where Dieulafoy's lesion may occur.

Dieulafoy's lesion is a rare but significant cause of gastrointestinal bleeding. It is characterized by a small, abnormally large artery that protrudes through the mucosa of the gastrointestinal tract, most commonly in the stomach. This condition can lead to severe, life-threatening bleeding if not promptly diagnosed and treated.

Pathophysiology

Dieulafoy's lesion is caused by an abnormally large submucosal artery that erodes through the gastric mucosa, leading to bleeding. Unlike peptic ulcers, there is no ulceration or erosion of the surrounding mucosa. The lesion is typically located within 6 cm of the gastroesophageal junction on the lesser curvature of the stomach, but it can also occur in other parts of the gastrointestinal tract, including the duodenum, jejunum, colon, and rectum.

Clinical presentation

Patients with Dieulafoy's lesion often present with sudden onset of massive hematemesis or melena. The bleeding is usually intermittent but can be severe enough to cause hypovolemic shock. Due to its rarity and the intermittent nature of the bleeding, Dieulafoy's lesion can be difficult to diagnose.

Diagnosis

The diagnosis of Dieulafoy's lesion is typically made via endoscopy, where the lesion appears as a small, pinpoint defect in the mucosa with active arterial bleeding or a visible vessel. In some cases, angiography may be used to identify the bleeding source, especially if endoscopy is inconclusive.

Treatment

The primary treatment for Dieulafoy's lesion is endoscopic intervention. Techniques such as endoscopic clipping, thermal coagulation, or band ligation are commonly used to control the bleeding. In cases where endoscopic treatment fails, angiographic embolization or surgical intervention may be necessary.

Prognosis

With prompt diagnosis and treatment, the prognosis for patients with Dieulafoy's lesion is generally good. However, delayed diagnosis or treatment can lead to significant morbidity and mortality due to massive bleeding.

Related pages

• Gastrointestinal bleeding
• Endoscopy
• Peptic ulcer disease