An uncommon cause of life-threatening gastrointestinal bleeding: 2 synchronous Dieulafoy lesions

doi:10.1016/j.jpedsurg.2008.09.033

Journal of Pediatric Surgery

Volume 44, Issue 2, February 2009, Pages 441-443

https://doi.org/10.1016/j.jpedsurg.2008.09.033 Get rights and content

Abstract

Dieulafoy lesions are a rather uncommon cause of gastrointestinal bleeding that can be torrential and life-threatening. Extragastric location and pediatric cases are very rare. We report the first case of synchronous Dieulafoy lesions in the stomach and jejunum. This case is discussed in the light of the reported literature on this condition.

Section snippets

Case report

A 15-year-old previously healthy Afro-Caribbean female presented with melena and hematemesis.

At the time of admission, she was noted to be tachycardic and hypotensive with a hemoglobin level of 7.8 g/dL and a normal clotting profile. Her initial hemodynamics improved after moderate volume crystalloid resuscitation, but the melena did not settle, and the patient became hemodynamically unstable. An urgent upper gastrointestinal endoscopy revealed moderate amount of altered blood in the stomach

Discussion

Dieulafoy lesions can be the source of significant gastrointestinal bleeding and account for between 0.3% and 1.5% of major gastrointestinal bleeds [3]. Dieulafoy lesions are thought to be congenital and although reports suggest preponderance in men of advancing age, they have also been reported in infants [4]. The presence of 2 actively bleeding lesions has been previously described only once, with dual gastric lesions [5], which were treated by endoscopic clipping.

This is the first report of

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Cited by (45)

Dieulafoy's lesion: Is there still a place for surgery? About 2 cases
2024, International Journal of Surgery Case Reports
Dieulafoy's lesion, a rare but life-threatening condition accounting for a small percentage of acute gastrointestinal bleeding cases, has historically posed diagnostic and therapeutic challenges.
In this article, we present two cases that required surgical intervention due to unsuccessful attempts with endoscopy. Case 1 involved a 40-year-old patient with a history of treated duodenal ulcers, while Case 2 featured a 74-year-old woman with no notable medical history. Both patients exhibited severe bleeding, necessitating urgent surgical procedures. The surgical approach involved wide gastrotomy, careful inspection, and successful suturing of the bleeding vessel.
Dieulafoy lesions, discovered by French surgeon Georges Dieulafoy in 1885, constitute 1–2 % of acute gastrointestinal bleeding cases. These anomalies involve enlarged submucosal arteries, predominantly in the stomach, but occurrences in other sites are documented. Endoscopic methods, surpassing surgical intervention, are preferred for treatment, boasting success rates over 90 %. Surgical measures become a last resort for uncontrolled bleeding, with laparoscopic surgery emerging as a minimally invasive alternative, facilitated by various intra-operative localization techniques. Laparoscopic wedge resection, in particular, exhibits lower re-bleeding rates than traditional oversewing methods, although feasibility depends on lesion location.
While endoscopic methods are preferred, surgery remains a vital option when bleeding persists or endoscopic intervention fails. This report highlights the significance of surgical management in selected cases of Dieulafoy's lesion.
Dieulafoy's lesion in the cecum: A rare case report presentation
2021, International Journal of Surgery Case Reports
Citation Excerpt :
The second hypothesis is based on a degenerative background caused by oxidative and ischemic stress of diverse or even multifactorial causes, such as chronic gastritis, previous surgeries, and alcohol consumption or non-steroidal anti-inflammatory drug usage [2,4,10–12]. Despite its uncertain pathogenesis, it is known that these vascular lesions are more frequent in the elderly or individuals with more underlying diseases [2,4,9,11,13]. Dieulafoy's lesions affect males twice as often as females and can occur at any age [2,5,14].
Dieulafoy's lesion is a rare entity, normally present in the stomach and more rarely in the colon, and it is responsible for 1% to 5% of acute gastrointestinal bleeding cases. Its true incidence may be underrated, since most cases are asymptomatic and difficult to diagnose despite endoscopic advances. We present a clinical case of acute gastrointestinal bleeding due to Dieulafoy's lesion in the cecum.
An 85-year-old woman presented with a clinical condition of haematochezia associated with anaemia and haemodynamic instability, needing blood transfusion. Colonoscopy demonstrated a Dieulafoy's lesion in the cecum with active bleeding, and haemostasis was performed successfully with localized adrenaline injection and haemostatic clip placement. Hospitalization occurred without further complications.
The diagnosis of Dieulafoy's lesion is difficult because it is a rare condition and thus, usually not included in the differential diagnosis of gastrointestinal bleeding. Its endoscopic diagnostic and therapeutic approach is the standard method in the event of an acute gastrointestinal bleeding episode, with greater efficiency with the combined use of haemostatic techniques. Surgery is necessary in less than 5% of cases when bleeding is not effectively controlled by endoscopic or angiographic techniques.
It is essential to be aware of this lesion as a possible cause of gastrointestinal bleeding and differentiate it from other causes. Advances in endoscopy have increased the rate of diagnosis of these lesions and reduced their associated mortality.
Dieulafoy lesion: the little known sleeping giant of gastrointestinal bleeds
2016, American Journal of Emergency Medicine
Dieulafoy lesion: CT diagnosis of this lesser-known cause of gastrointestinal bleeding
2015, Clinical Radiology
Citation Excerpt :
They are most commonly located along the lesser curvature, within 6–10 cm of the gastro-oesophageal junction.11 Although Dieulafoy lesions are commonly thought to be quite rare, accounting for only 1–2% of acute gastrointestinal bleeding,1,12 their apparent rarity is at least in part related to under-diagnosis. A Dieulafoy lesion is usually asymptomatic until presentation with an often massive bleed.
A Dieulafoy lesion describes a tortuous, submucosal artery in the gastrointestinal tract—most commonly the posterior stomach—that penetrates through the mucosa over time, eventually perforating to cause severe gastrointestinal bleeding. Due to its insidious onset, tendency to cause intermittent but severe bleeding, and difficulty of endoscopic diagnosis, Dieulafoy lesion has a very high mortality rate. Although originally thought not to be a radiologically diagnosable entity, Dieulafoy lesions can be seen at enhanced CT of the abdomen. The purpose of this review is to summarize the pathophysiology, epidemiology, diagnosis, and management of Dieulafoy lesions with a focus on diagnostic findings at enhanced CT imaging.
Multiple Gastric Dieulafoy Lesions
2023, ACG Case Reports Journal
A Case Report of Profuse Bleeding in the Lower Gastrointestinal Tract due to Dieulafoy Lesion in the Rectum
2023, Acta Medica Indonesiana

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Independent case reportAn uncommon cause of life-threatening gastrointestinal bleeding: 2 synchronous Dieulafoy lesions

Abstract

Section snippets

Case report

Discussion

Gastrointest Endosc

J Pediatr Surg

Gastrointest Endosc

Am J Gastroenterol

Dieulafoy's lesion: an obscure cause of GI bleeding

J R Coll Surg Edinb

Independent case report
An uncommon cause of life-threatening gastrointestinal bleeding: 2 synchronous Dieulafoy lesions