Dieulafoy lesions are uncommon but important causes of acute upper gastrointestinal bleeding. A Dieulafoy lesion is characterized by a dilated tortuous submucosal artery that erodes overlying gastrointestinal mucosa most commonly found in the stomach.
- contributes to ~1.5% of all acute gastrointestinal bleeding 1
- male : female 2:1
- can occur at any age but presents more commonly in older patients
Patients present with hematemesis, which can be massive, and/or melena 1.
Dieulafoy lesions are dilated and tortuous submucosal arteries that erode the overlying gastrointestinal mucosa and result in bleeding 2.
Although they can be present throughout the gastrointestinal tract, approximately 70% are located in the stomach.
CT angiogram may show:
- enlarged submucosal vessel with or without active contrast extravasation
- vessels can appear linear or serpentine, or as a nonspecific blush of mucosal/submucosal contrast 3
Treatment and prognosis
Endoscopic treatment is the treatment of choice and has reported success rate over 90% 4. Angiography plus embolization or surgery can be considered in refractory cases.
History and etymology
It was first described by M T Gallard a French surgeon in 1884 but was described in more detail by Paul Georges Dieulafoy, another French surgeon in 1898 5.
- 1. Veldhuyzen van Zanten SJ, Bartelsman JF, Schipper ME, Tytgat GN. Recurrent massive haematemesis from Dieulafoy vascular malformations--a review of 101 cases. (1986) Gut. 27 (2): 213-22. Pubmed
- 2. Lee YT, Walmsley RS, Leong RW, Sung JJ. Dieulafoy's lesion. (2003) Gastrointestinal endoscopy. 58 (2): 236-43. doi:10.1067/mge.2003.328 - Pubmed
- 3. Batouli A, Kazemi A, Hartman MS, Heller MT, Midian R, Lupetin AR. Dieulafoy lesion: CT diagnosis of this lesser-known cause of gastrointestinal bleeding. (2015) Clinical radiology. 70 (6): 661-6. doi:10.1016/j.crad.2015.02.005 - Pubmed
- 4. M Baxter, EH Aly. Dieulafoy's lesion: current trends in diagnosis and management. (2015) The Annals of The Royal College of Surgeons of England. 92 (7): 548-54. doi:10.1308/003588410X12699663905311 - Pubmed
- 5. Dieulafoy G. Exulceratio simplex. L’intervention chirurgicale dans les hematemeses foudroyantes consecutives a l’exulceration simple de l’estomac. (1898) Bull Acad Med. 49:49–84.