Dieulafoy's lesion

Until recently, surgery has been the only effective management for Dieulafoy's lesions.

Similar to other reports we also identified Dieulafoy's lesion in the duodenum.

Dieulafoy's lesion is a disease of mainly middle aged and elderly male patients.

A case is reported of Dieulafoy's lesion with haemodynamically relevant bleeding.

A Dieulafoy's lesion is difficult to diagnose, because of the intermittent pattern of bleeding.

The incidence of Dieulafoy's lesions among patients with acute upper gastrointestinal bleeding varies from 0.5% to 14%, mainly depending upon selection criteria.

Pathological examination of the resected specimens in two cases showed the typical appearance of Dieulafoy's lesion.

Interestingly, one patient experienced recurrence of Dieulafoy's lesion at the identical site half a year after successful treatment and with healing proved endoscopically.

Our study with a mean follow up period of 28.3 months (range 2-80) clearly shows the longterm effectiveness of endoscopic treatment of Dieulafoy's lesion.

In 21 patients Dieulafoy's lesions presented with sudden and massive gastric bleeding with haematemesis and melaena.

He is best known for his study of acute appendicitis and his description of Dieulafoy's lesion, a rare cause of gastric bleeding.

Dieulafoy's lesions occur twice as often in men as women and patients typically have multiple comorbidities, including hypertension, cardiovascular disease, chronic kidney disease, and diabetes.

Dieulafoy's lesion (exulceratio simplex Dieulafoy) is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds.

Peptic (gastric) ulcer - (Cushing ulcer, Dieulafoy's lesion)

Approximately 75% of Dieulafoy's lesions occur in the upper part of the stomach within 6 cm of the gastroesophageal junction, most commonly in the lesser curvature.

As a result of restricting our study to non-variceal bleeding and a high referral rate from other hospitals there is a seemingly high incidence of Dieulafoy's lesion in our patients.

Some authors have also described significant concurrent morbidity or remarkable past medical history, while others have described the 'typical patient' with Dieulafoy's lesion to have an unremarkable past medical history.

Many bleeding lesions have been successfully clipped, including bleeding peptic ulcers, Mallory-Weiss tears of the esophagus, Dieulafoy's lesions, stomach tumours, and bleeding after removal of polyps.

Another patient experienced a recurrence of Dieulafoy's lesion half a year after an initially successful endoscopic approach and had surgical intervention without a further endoscopic attempt (histologically proved case of Dieulafoy's disease, see the Figure).

Dieulafoy's Lesions are characterized by a single large tortuous arteriole in the submucosa which does not undergo normal branching or a branch with caliber of 1-5 mm (more than 10 times the normal diameter of mucosal capillaries).

Three patients had a history of previous bleeding from ulcers of the duodenum or stomach, one patient experienced anastomosal bleeding with a history of gastric resection, one patient had a Dieulafoy's lesion treated conservatively in another hospital with recurrent bleeding episodes within one year before admission.