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CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 30-31

Dieulafoy lesion: A rare cause of gastrointestinal bleeding


1 Department of Medicine, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India
2 Department of Pathology, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India
3 Department of Gastroenterology, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India

Date of Web Publication16-Mar-2015

Correspondence Address:
Dr. Aswini Kumar Sahoo
Department of Medicine, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram - 535 217, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.153312

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  Abstract 

Dieulafoy lesion is characterized by exteriorization of a large pulsatile arterial vessel through a minimal mucosal tear surrounded by normal mucosa, causing massive and recurrent upper digestive bleeding in previously healthy patients. More frequently presented than diagnosed, with the increase of its knowledge among endoscopists, a large number of cases are expected in the literature. Dieulafoy lesion is a distinct nosologic entity that must be suspected in patients with massive digestive bleeding. Endoscopy became the procedure of choice for diagnosis and treatment of this disease.

Keywords: Dieulafoy lesion, endoscopy, gastrointestinal bleeding


How to cite this article:
Sahoo AK, Rauta S, Chandra MS, Akbar M, Padhy PK. Dieulafoy lesion: A rare cause of gastrointestinal bleeding. J NTR Univ Health Sci 2015;4:30-1

How to cite this URL:
Sahoo AK, Rauta S, Chandra MS, Akbar M, Padhy PK. Dieulafoy lesion: A rare cause of gastrointestinal bleeding. J NTR Univ Health Sci [serial online] 2015 [cited 2019 Aug 18];4:30-1. Available from: http://www.jdrntruhs.org/text.asp?2015/4/1/30/153312


  Introduction Top


Dieulafoy lesion is an uncommon cause of major gastrointestinal (GI) bleeding and may be difficult to recognize. It consists of a large caliber artery that protrudes through a mucosal defect in the stomach causing significant and often recurrent hemorrhage from a pinpoint non-ulcerated arterial lesion. [1],[2] It has been identified more frequently in recent years due to increased awareness. Dieulafoy lesion is thought to be the cause of acute and chronic upper GI bleeding in approximately 1-2% of these cases. [3]


  Case Report Top


The present case is about a 19-year-old male patient with a non-significant past medical history presented to the hospital with dizziness, light-headedness, headache, progressive dyspnea, bilateral leg swelling and a fever for 2 days. He also had three episodes of coffee ground vomiting and melena on the day of admission. He was a non-smoker, non-drinker and denied any drug abuse. His blood pressure was 100/50 mm of Hg, pulse rate was 116/min. He was lethargic and dyspneic and his skin and conjunctiva were pale. Lung examination was normal, but the cardiovascular exam revealed tachycardia. While the abdominal examination was unremarkable, he had tarry stools on rectal exam. Extremity examination revealed moderate bilateral ankle edema. His blood test showed a hemoglobin of 4.8 g/dL, albumin of 2.8 and a total protein of 4.5. His electrolytes and chemistry were within the normal limits. He was admitted to the intensive care unit with a diagnosis of upper GI bleeding and severe anemia. Upper gastrointestinal endoscopy has shown dieulafoy lesion [Figure 1] and [Figure 2]. Treatment with intravenous fluids and packed red blood cells was started. Electrocoagulation was carried out and his symptoms improved markedly in a few days. [4]
Figure 1: Upper gastrointestinal endoscopy shows Dieulafoy lesion

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Figure 2: Upper gastrointestinal endoscopy shows Dieulafoy lesion

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  Discussion Top


Dieulafoy lesion should be considered when evaluating any acute and recurrent major GI bleeding. If unrecognized, it may cause a life-threatening hemorrhage. Awareness of the condition is a key to accurate diagnosis. It can be easily overlooked at endoscopy as concomitant lesions such as ulcers or varices may wrongly be considered responsible for the bleeding episode. Treatment is by endoscopic modalities like electrocoagulation and successfully achieves permanent hemostasis in 85% of cases. [4] In practice, we have to consider unusual causes of common diseases to decrease their mortality and morbidity.

 
  References Top

1.
Veldhuyzen van Zanten SJ, Bartelsman JF, Schipper ME, Tytgat GN. Recurrent massive haematemesis from dieulafoy vascular malformations: A review of 101 cases. Gut 1986;27:213-22.  Back to cited text no. 1
[PUBMED]    
2.
Chaer RA, Helton WS. Dieulafoy's disease. J Am Coll Surg 2003;196:290-6.  Back to cited text no. 2
    
3.
British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: Guidelines. Gut 2002;51 Suppl 4:iv1-6.  Back to cited text no. 3
[PUBMED]    
4.
Chung IK, Kim EJ, Lee MS, Kim HS, Park SH, Lee MH, et al. Bleeding Dieulafoy's lesions and the choice of endoscopic method: Comparing the hemostatic efficacy of mechanical and injection methods. Gastrointest Endosc 2000;52:721-4.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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