Diagnosis

Dieulafoys lesion

Etiology

Cause [yv5][nar]

• A developmental vascular malformation

• Trigger of rupture:

  • NSAIDs, aspirin and warfarin, tobacco, alcohol, and peptic ulcer disease

Pathophysiology [yv5]

• A large submucosal artery become ulcerated and rupture usually in the setting of chronic gastritis

• Presents with massive life-threatening gastrointestinal bleeding

Complications [yv5]

• Spontaneous gastrointestinal hemorrhage

• Hemodynamic instability

• Iron deficiency anemia

Epidemiology

Incidence per 100.000 [nar][cza][thw]

Approach

• Blood test

• Blood gas

• Gastroscopy

Treatment

1. Endoscopic hemostatic procedures: [gq5][yv5]

   • Thermal – electrocoagulation, heat probe and argon plasma coagulation

   • Regional injection – local epinephrine injection and sclerotherapy

   • Mechanical – banding and hemoclip

2. Angiography and embolisation:

   • If failed endoscopic methods of hemostasis

   • Lower GI bleeding or lesions beyond reach of therapeutic endoscopy

   • Poor candidates for surgery

3. Surgical treatment (laparoscopic):

   • Intra-operative endoscopy for real-time localisation of the lesion

   • Gastrotomy and wide-wedge resection

   • Gastrectomy

Differential diagnoses

Angiodysplasia, Aortoenteric fistula, Arteriovenous malformation, Dengue fever, Esophageal cancer, Esophageal varices, Esophagitis, Gastric cancer, Gastric outlet obstruction, Gastrinoma, Gastritis, Hypovolemia, Mallory-Weiss tear, Ulcer disease, von Willebrand disease, Zollinger-Ellison syndrome