Dieulafoy lesion

Dieulafoy Lesion A Dieulafoy lesion is a rare but potentially life-threatening condition characterized by a large tortuous arteriole in the submucosa, which can erode and cause significant gastrointestinal bleeding. This condition is named after the French surgeon Paul Georges Dieulafoy, who first described it in the late 19th century.

Pathophysiology

The pathophysiology of a Dieulafoy lesion involves an abnormally large submucosal artery that protrudes through a small mucosal defect. Unlike other causes of gastrointestinal bleeding, such as peptic ulcers, the mucosal defect in Dieulafoy lesions is minimal, often less than 3 mm in diameter. The lesion is most commonly found in the proximal stomach, particularly along the lesser curvature, but can occur anywhere in the gastrointestinal tract.

Clinical Presentation

Patients with a Dieulafoy lesion typically present with acute, massive gastrointestinal bleeding. Symptoms may include hematemesis (vomiting blood), melena (black, tarry stools), or hematochezia (passage of fresh blood through the anus). Due to the rapid loss of blood, patients may also exhibit signs of hypovolemic shock, such as hypotension, tachycardia, and pallor.

Diagnosis

Diagnosing a Dieulafoy lesion can be challenging due to its rarity and the small size of the mucosal defect. Endoscopy is the primary diagnostic tool, allowing direct visualization of the lesion. During endoscopy, the lesion may appear as a small, bleeding point or a visible vessel without an associated ulcer. In some cases, angiography or CT angiography may be used to identify the source of bleeding.

Treatment

The treatment of a Dieulafoy lesion focuses on controlling the bleeding and preventing recurrence. Endoscopic techniques are the first line of treatment and may include:

• Endoscopic clipping: Mechanical clips are applied to the bleeding vessel to achieve hemostasis.
• Thermal coagulation: Techniques such as argon plasma coagulation or bipolar electrocoagulation are used to cauterize the vessel.
• Injection therapy: Epinephrine or sclerosants may be injected to induce vasoconstriction and promote clot formation.

In cases where endoscopic treatment fails or is not feasible, surgical intervention or angiographic embolization may be necessary.

Prognosis

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

Epidemiology

Dieulafoy lesions are rare, accounting for less than 2% of all cases of acute gastrointestinal bleeding. They are more common in males and typically present in middle-aged to elderly patients.

See Also

• Gastrointestinal bleeding
• Endoscopy
• Hypovolemic shock

External Links

• [Link to a reputable medical resource on Dieulafoy lesions]

NIH genetic and rare disease info

• NIH info on Dieulafoy lesion

Dieulafoy lesion is a rare disease.