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Dieulafoy's lesion

Diagnosis and management

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Abstract

A review of 177 cases of upper gastrointestinal hemorrhage due to Dieulafoy's lesion is reported. Dieulafoy's lesion is frequently responsible for severe and recurrent upper gastrointestinal hemorrhage. The lesion was predominantly found in the proximal stomach. Repeat endoscopies were needed in 33% of the patients in order to make the correct diagnosis. When preoperative diagnosis and localization were made, surgery was an effective therapeutic modality. Therapeutic endoscopy was successful in achieving permanent hemostasis in 85% of the reported cases. Re-treatment was needed in an additional 10% and surgical therapy in 5% of the cases. Therapeutic endoscopy should be considered initially in all patients. Surgical intervention and angiography with embolization may be effective options if endoscopic therapy is unsuccessful.

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References

  1. Gallard MT: Aneurysmes miliaires de l'estomac. Soc Med Hop Bull Mim Soc Med, Hop 84, 1884

  2. Dieulafoy G: L'exulceratio simple.In Manuel de Pathologie Interne. Paris, Masson, 1908, pp 178–305

    Google Scholar 

  3. Broberg A, Ihre T, Pyk E, Raaschou-Nielson T: Exulceration simplex as a conceivable cause of massive gastric hemorrhage. Surg Gynecol Obstet 154:186–188, 1982

    Google Scholar 

  4. Strong RW: Dieulafoy's disease: A distinct clinical entity. Aust NZ J Surg 54:337–339, 1984

    Google Scholar 

  5. Asaki S, Sato H, Nishimura T, Ohkubo S, Yamagata R, Ito S, Saito Y, Miyazaki S, Yaginumi N: Endoscopic diagnosis and treatment of Dieulafoy's ulcer. Tohoku J Exp Med 154:135–141, 1988

    Google Scholar 

  6. Lin HJ, Lee FY, Tsai YT, Lee SD, Lee CH, Kang WM: Therapeutic endoscopy for Dieulafoy's disease. J Clin Gastroenterol 11(5):507–510, 1989

    Google Scholar 

  7. Juler GL, Labitzke HG, Lamb R, Allen R: The pathogenesis of Dieulafoy's gastric erosion. Am J Gastroenterol 79:195–200, 1984

    Google Scholar 

  8. Goldman RL: Submucosal arterial malformation (“aneurysm”) of the stomach with fatal hemorrhage. Gastroenterology 46:589–594, 1964

    Google Scholar 

  9. Veldhuyzen van Zanten SJO, Bartlesman JFWM, Schipper MEI, Tytgat GNT: Recurrent massive hematemesis from Dieulafoy vascular malformations—a review of 101 cases. Gut 27:213–222, 1986

    Google Scholar 

  10. Hoffmann J, Beck H, Jensen HE: Dieulafoy's lesion. Surg Gynecol Obstet 159:537–540, 1984

    Google Scholar 

  11. Pointer R, Schwab G, Konigsrainer •, Dietze O: Endoscopic treatment of Dieulafoy's disease. Gastroenterology 94:563–566, 1988

    Google Scholar 

  12. Frank W: Hematemesis associated with gastric arteriosclerosis. Gastroenterology 7:231–240, 1946

    Google Scholar 

  13. Mallory T: Case 32402. N Engl J Med 235:524–527, 1946

    Google Scholar 

  14. Donaldson GA, Hamlin E Jr: Massive hematemesis resulting from rupture of a gastric artery aneurysm. Report of three cases. N Engl J Med 243:369–373, 1950

    Google Scholar 

  15. Millard M: Fatal rupture of gastric aneurysm. Arch Pathol 59:363–371, 1955

    Google Scholar 

  16. Antonie T: Arteriosclerosis of the arteries of the stomach. Med J Aust 48:210–211, 1961

    Google Scholar 

  17. Chapman I, Lapi N: A rare course of gastric hemorrhage. Arch Intern Med 112:347–351, 1963

    Google Scholar 

  18. Markby CEP: Massive hemorrhage from superficial gastric erosions. Br J Surg 52(9):685–691, 1965

    Google Scholar 

  19. Bongiovi JJ, Duffy JL: Gastric hemangioma associated with upper gastrointestional bleeding. Arch Surg 95:93–98, 1967

    Google Scholar 

  20. Rossi NP, Green EW, Pike JD: Massive bleeding of the upper gastrointestional tract due to Dieulafoy's erosion. Arch Surg 97:797–800, 1968

    Google Scholar 

  21. Richter RM: Massive gastric hemorrhage from submucosal arterial malformation. Am J Gastroenterol 64:324–326, 1975

    Google Scholar 

  22. Palmer ED, Boyce HW Jr: Sclerotic submucosal gastric artery: A source of hemorrhage. Am Surg 30(2):83–87, 1964

    Google Scholar 

  23. Gough MH: Submucosal arterial malformation of the stomach as the probable cause of recurrent severe hematemesis in a 16-year-old girl. Br J Surg 64:522–524, 1977

    Google Scholar 

  24. Sherman L, Shenoy SS, Satchidanand SK, Neumann PR, Barrios GG, Peer RM: Arteriovenous malformation of the stomach. Am J Gastroenterol 72:160–164, 1979

    Google Scholar 

  25. Helliwell M, Irving JD: Hemorrhage from gastric artery aneurysms. Br Med J 282:460–461, 1981

    Google Scholar 

  26. MacMortensen NJ, Mountford RA, Davis JD, Jeans WD: Dieulafoy's disease: A distinctive arteriovenous malformation causing massive gastric hemorrhage. Br J Surg 70:76–78, 1983

    Google Scholar 

  27. Bakka A, Rosseland AR: Massive gastric bleeding from exulceratio simplex (Dieulafoy). Acta Chir Scand 152:285–288, 1986

    Google Scholar 

  28. Boron B, Mobarhan S: Endoscopic treatment of Dieulafoy hemorrhage. J Clin Gastroenterol 9(5):518–520, 1987

    Google Scholar 

  29. Al-Kawas FH, O'Keefe J: Nd∶YAG laser treatment of a bleeding Dieulafoy's lesion. Gastrointest Endosc 33(1):38–39, 1987

    Google Scholar 

  30. Louwerens JWK, Gratama S, Zwaan A, van der Schaar H: Dieulafoy's erosion in the stomach as a result of intraabdominal vascular anomaly. Br J Surg 75:489–490, 1988

    Google Scholar 

  31. McClave SA, Goldschmid S, Cunningham JT, Boyd W Jr: Dieulafoy's cirsoid aneurysm of the duodenum. Dis Dis Sci 33:801–805, 1988

    Google Scholar 

  32. Matuchansky C, Babin P, Abadie JC, Payen J, Gasquet C, Barbier J: Jejunal bleeding from a solitary large submucosal artery. Gastroenterology 75:110–113, 1978

    Google Scholar 

  33. Boix J, Humbert P, Fernandez-Llamazares J, Planas R, Ojanguren I, Salva JA: Dieulafoy malformation. Dig Dis Sci 33(11):1496–1497, 1988

    Google Scholar 

  34. DeVirgilio C, Dubrow TJ, Robertson JM, Wackym PA, Pelikin PCD, Cobb S, Williams RA: Dieulafoy's lesion associated with truncus arteriosus type IV: An unusual source of upper gastrointestinal hemorrhage. Am J Gastroenterol 83:865–867, 1988

    Google Scholar 

  35. Okada M, Iida M, Fuchigami T, Ohgushi H, Omae T, Kimura Y, Kido H: Submucosal arterial malformation of the stomach diagnosed endoscopically. Gastrointest Endosc 29(1):30–31, 1983

    Google Scholar 

  36. Sarles HE Jr, Schenkein JP, Hecht RM, Sanowski RA, Miller P: Dieulafoy's ulcer: A rare source of massive gastric hemorrhage in an 11-year-old girl: Case report and literature review. Am J Gastroenterol 79:930–932, 1984

    Google Scholar 

  37. Barbier P, Luder P, Triller J, Ruchti CH, Hassler H, Stafford A: Colonic hemorrhage from a solitary minute ulcer. Report of three cases. Gastroenterology 88:1065–1068, 1985

    Google Scholar 

  38. Barlow TE, Bentley FH, Walder DN: Arteries, veins and arteriovenous anastomoses in the human stomach. Surg Gynecol Obstet 93:657–671, 1951

    Google Scholar 

  39. Miko TL, Thomazy VA: The caliber persistent artery of the stomach: A unifying approach to gastric aneurysm, Dieulafoy's lesion and submucosal arterial malformation. Hum Pathol 19:914–921, 1988

    Google Scholar 

  40. Fleischer DE: Endoscopic therapy of upper gastrointestinal bleeding in humans. Gastroenterology 90:217–234, 1986

    Google Scholar 

  41. Papp JP: Endoscopic electrocoagulation in the management of upper gastrointestinal tract bleeding. Surg Clin North Am 62:797–806, 1982

    Google Scholar 

  42. Steele RJC: Endoscopic haemostasis for non-variceal upper gastrointestinal hemorrhage. Br J Surg 76:219–225, 1989

    Google Scholar 

  43. Moore JP, Silvis SE, Vennes JA: Evolution of bipolar electrocoagulation in canine stomachs. Gastrointest Endosc 24:148–151, 1978

    Google Scholar 

  44. Laine L: Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. N Engl J Med 316:1613–1617, 1987

    Google Scholar 

  45. Laine L: Multipolar electrocoagulation for the treatment of ulcers with non-bleeding visible vessels: A prospective controlled trial. Gastroenterology 94:A246, 1988

    Google Scholar 

  46. Asaki S: Endoscopic hemostasis of gastrointestinal hemorrhage by local application of absolute ethanol: A clinical study. Tohoku J Exp Med 141:373–383, 1983

    Google Scholar 

  47. Sugawa C, Fujita Y, Ikeda T, Walt AJ: Endoscopic hemostasis by local injection of ninety-eight per cent dehydrated ethanol. Surg Gynecol Obstet 162:159–163, 1986

    Google Scholar 

  48. Soehendra N: Injection of non-variceal bleeding in the upper gastrointestinal tract. Endoscopy 17:129–132, 1985

    Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Georgetown University Medical Center, Room 2118, 3800 Reservoir Road, NW, 20007, Washington, D.C.

    Harold F. Reilly III MD &  Firas H. Al-Kawas MD

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  1. Harold F. Reilly III MD
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  2. Firas H. Al-Kawas MD
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Reilly, H.F., Al-Kawas, F.H. Dieulafoy's lesion. Digest Dis Sci 36, 1702–1707 (1991). https://doi.org/10.1007/BF01296613

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  • DOI: https://doi.org/10.1007/BF01296613

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