World Library  
Flag as Inappropriate
Email this Article

Dieulafoy's lesion

Article Id: WHEBN0000732141
Reproduction Date:

Title: Dieulafoy's lesion  
Author: World Heritage Encyclopedia
Language: English
Subject: Paul Georges Dieulafoy, Melena, Gastrointestinal disease, Upper gastrointestinal bleeding, Dieulafoy
Collection: Stomach Disorders
Publisher: World Heritage Encyclopedia

Dieulafoy's lesion

Dieulafoy's lesion
Blood supply of stomach
Classification and external resources
ICD-10 K25
ICD-9-CM 537.84
DiseasesDB 33135

Dieulafoy's lesion (exulceratio simplex Dieulafoy) is a medical condition characterized by a large tortuous [2][3] It is also called "caliber-persistent artery" or "aneurysm" of gastric vessels. However, unlike most other aneurysms these are thought to be developmental malformations rather than degenerative changes.


  • Presentation 1
  • Symptoms 2
  • Treatment 3
  • Prognosis 4
  • References 5


Dieulafoy's Lesions are characterized by a single large tortuous small artery[4] 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). The lesion bleeds into the gastrointestinal tract through a minute defect in the mucosa which is not a primary ulcer of the mucosa but an erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole.

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. Extragastric lesions have historically been thought to be uncommon but have been identified more frequently in recent years, likely due to increased awareness of the condition. The duodenum is the most common location (14%) followed by the colon (5%), surgical anastamoses (5%), the jejunum (1%) and the esophagus (1%).[5] The pathology in these extragastric locations is essentially the same as that of the more common gastric lesion.

In contrast to peptic ulcer disease, a history of alcohol abuse or NSAID use is usually absent in DL.

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.


The symptoms due to bleeding are hematemesis and/or melena.[6]

Presenting Symptoms
Recurrent hematemesis with melena 51% of cases
Hematemesis without melena 28% of cases
Melena with no hematemesis 18% of cases

A Dieulafoy's lesion is difficult to diagnose, because of the intermittent pattern of bleeding. Endoscopically it is not easy to recognize and therefore sometimes multiple views have to be performed over a longer period. Today angiography is a good additional diagnostic, but then it can only be seen during a bleeding at that exact time.


It is diagnosed and treated endoscopically, however endoscopic ultrasound or angiography can be of benefit.

Endoscopic techniques used in the treatment include epinephrine injection followed by bipolar or monopolar electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, hemoclipping or banding. Alternatively, Interventional Radiology may be consulted for an angiogram with subselective embolization.


The mortality rate for Dieulafoy's was much higher before the era of endoscopy, where open surgery was the only treatment option.


  1. ^ Akhras J, Patel P, Tobi M (March 2007). "Dieulafoy's lesion-like bleeding: an underrecognized cause of upper gastrointestinal hemorrhage in patients with advanced liver disease". Dig. Dis. Sci. 52 (3): 722–6.  
  2. ^ synd/3117 at Who Named It?
  3. ^ G. Dieulafoy. Exulceratio simplex: Leçons 1-3. In: G. Dieulafoy, editor: Clinique medicale de l'Hotel Dieu de Paris. Paris, Masson et Cie: 1898:1-38.
  4. ^ Eidus, LB.; Rasuli, P.; Manion, D.; Heringer, R. (Nov 1990). "Caliber-persistent artery of the stomach (Dieulafoy's vascular malformation).". Gastroenterology 99 (5): 1507–10.  
  5. ^ Lee Y, Walmsley R, Leong R, Sung J (2003). "Dieulafoy's Lesion". Gastrointestinal Endoscopy 58 (2): 236–243.  
  6. ^ al-Mishlab, T; Amin, AM; Ellul, JP (August 1999). "Dieulafoy's lesion: an obscure cause of GI bleeding.". Journal of the Royal College of Surgeons of Edinburgh 44 (4): 222–5.  
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from World Library are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.