Dieulafoy lesion

Dieulafoy lesions (also known as exulceratio simplex) are uncommon but important causes of acute upper gastrointestinal bleeding. The lesion is characterized by a dilated tortuous submucosal artery that erodes overlying gastrointestinal mucosa and is most commonly found in the stomach.  

Epidemiology

Dieulafoy lesions can occur at any age but more commonly present in older patients. There is a male predilection of 2:1. They contribute to ~1.5% of all acute gastrointestinal bleeding ¹.

Clinical presentation

Patients present with hematemesis, which can be massive, and/or melena ¹.

Pathology

Dieulafoy lesions are dilated and tortuous submucosal arteries that erode the overlying gastrointestinal mucosa and result in bleeding ².

Location

Although they can be present throughout the gastrointestinal tract, approximately 70% are located in the stomach.

• gastric: In the stomach, the lesser curvature is the commonest location

• extragastric: in descending order of frequency, appearance in the duodenum, right colon, esophagus, rectum, and anal canal have been described 

• rare cases outside the gastrointestinal tract entirely, e.g. bronchus ^8,9

Radiographic features

CT

CT angiogram may show:

• enlarged submucosal vessel with or without active contrast extravasation

• vessels can appear linear or serpentine or as a non-specific blush of mucosal/submucosal contrast ³

Treatment and prognosis

Endoscopic treatment is the treatment of choice and has a reported success rate of >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 (1839-1911) ⁶, another French surgeon, in 1898 ⁵.