Dieulafoy's Lesion: Pathology, Diagnosis and Treatment

Authors

  • Sunthorn Treesaranuwattana Department of Surgery, St. Mary Hospital, Nakhon Ratchasima, Thailand 30000
  • Choosak Khemtai Division of Emergency, St. Mary Hospital, Nakhon Ratchasima, Thailand 30000

Abstract

Background: Dieulafoy's lesion is un common cause of a cute gastrointestinal bleeding which is potentially life threatening if unrecognized. It may be overlooked during endoscopy or even laparotomy. Understanding of this pathology will improve the diagnostic accuracy and selection of effective hemostatic procedure.

Methods: Data were reviewed from published literature searching Medline database and reference lists of relevant major articles. Figures were collected from authors experience.

Results: About 341 cases of Dieulafoy's lesion of gastrointestinal tract have been reported in English literature up to year 2001. In the early reports most of them were gastric lesion and surgery was the mainstay for treatment and diagnosis with high mortality. After the advent of flexible endoscope, much increase of reported cases included extragastric Dieulafoy's lesions. Currently, therapeutic endoscopy is the treatment of choice while surgery is indicated when endoscopy fails to arrest the bleeding or is inaccessible or unavailable.

Conclusion: Dieulafoy's lesion is underdiagnosed rather than a rare disease. Endoscopy is the essential diagnostic procedure and therapeutic endoscopy is safe and effective for permanent hemostasis. Surgical treatment is required in about 5 per cent of cases.

References

1. Goldman RL. Submucosal arterial malformation (“aneurysm”) of the stomach with fatal hemorrhage. Gastroenterology 1964; 46: 589-94.

2. Fockens P, Tytgat GNJ. Dieulafoy's disease. Gastrointest Endosc Clin N Am 1996;6: 739-52.

3. Lin HJ, Lee FY, Tsai YT, Lee SD, Lee CH, Kang WM. Therapeutic endoscopy for Dieulafoy's disease. J Clin Gastroenterol 1989;11:507-10.

4. Chung IK, Kim EJ, Kim HS, Lee MS, Park SH, Lee MH, et al. Bleeding Dieulafoy lesion and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods. Gastrointest Endosc 2000;52:721-4

5. Veldhuyzen VanZanten SJ0, Bartlesman JFWA, Shipper MEI, Tytgat GNJ. Recurrent massive haematemesis from Dieulafoy vascular malformations-a review of 101 cases. Gut 1986;27:213-22.

6. Reilly HF, Al-Kawas FH. Dieulafoy's lesion, diagnosis and management. Dig Dis Sci 1991; 36: 1702-7.

7. Stark ME, Gostout CJ, Balm RK. Clinical feature and endoscopic management of Dieulafoy's disease. Gastrointest Endosc 1992; 38: 545-50.

8. Baettig B, Haecki W, Lammer F, Jost R. Dieulafoy's disease: Endoscopic treatment and follow-up. Gut 1993; 34:1418-21.

9. Norton ID, Peterson BT, Sorbi D, Balm RK, Alexander GL, Gostout CJ. Management and long-term prognosis of Dieulafoy lesion. Gastrointest Endosc 1999; 50: 762-7.

10. Jaspersen D, Korner T, Schorr W, Brennelstuhl M, Hammar CH, Extragastric Dieulafoy's disease as unusual source of intestinal bleeding, esophageal visible vessel, Dig Dis Sci 1994:31;2558-60.

11. Scheider DM, Barthel JS, King PD, Beale GD. Dieulafoy like lesion of the distal esophagus. Am J Gastroenterol 1994; 89:2080-1.

12. Bozkurt T, Lederer PC, Lux G. Esophageal visible vessel as a cause of massive upper gastrointestinal hemorrhage. Endoscopy 1991; 23: 16-8.

13. Rabago L, Mora P, Gea F, Martinez P, Ruiperez J, Campose R. An unusual source of gastrointestinol bleeding from esophagus. Endoscopy 1993; 25: 197-8.

14. Soetikno RM, Piper J, Hontes H, Ukomadu C, Carr-Locke DL. Use of endoscopic band ligation to treat a Dieulafoy's lesion of the esophagus. Endoscopy 2000; 32: S15.

15. Anireddy D, Timberlake G, Seibert D. Dieulafoy's lesion of the esophagus. Gastrointest Endosc 1993; 39: 604.

16. McClave SA, Goldschmid S, Cunningham JT, Boyd WP. Dieulafoy's cirsiod aneurysm of the duodenum. Dig Dis Sci 1988; 33:801-5.

17. Goldenberg SP, DeLuca VAJr, Marignani P, Endoscopic treatment of Dieulafoy's lesion of duodenum. Am J Gastroenterol 1990; 85: 452-4.

18. Pollack R. Lipsky H, Goldberge RI. Duodenal Dieulafoy's lesion. Gastrointest Endosc 1993; 39: 820-2.

19. Choudari CP, Palmerk R. Dieulafoy’s lesion of the duodenum; successful endoscopic therapy. Endoscopy 1993;25:371.

20. Steinert D, Masand-Rai A. Successful combination endoscopic therapy for duodenal Dieulafoy's lesion. AJG 1996;91:818-9.

21. Hokama A, Ikema R, Hanashiro K, Kinjo F, Saito A. Endoscopic hemoclipping for duodenal Dieulafoy's lesion. AJG 1996;91:2450.

22. Suoka N, Koizumi N, Inokuchi K, Wakabayashi I. Combined endoscopic clipping and ethanol injection for treatment of Dieulafoy's lesion in the duodenum. Gastrointest Endosc 1997;46:574-5.

23. Hokama A, Kinjo F, Saito A. Endoscopic clipping of duodenal Dieulafoy's lesion: alone or combined ? Gastrointest Endosc 1998; 48: 336-7.

24. Deutsch G, Hanly M, Yeh KA. Jejunal cirsoid aneurysm: A rare cause of massive lower gastrointestinal hemorrhage. Am Surg 1998; 64: 1179-82.

25. Matuchansky C, Babin P, Abadie JC, Payen J, Gasquet C, Barbier J. Jejunal bleeding from a solitary large submucosal artery. Gastroenterology 1978;75: 110-3.

26. Fox A, Ravi K, Leeder PC, Britton CJ, Warren BE. Adult small bowel Dieulafoy lesion. Postgrad Med J 2001;77:783-784.

27. Chen KTK. Intestinal bleeding from a caliber-persistent submucosal artery in the ileum. J Clin Gastroenterol 1985;7:289-91.

28. Sone H, Nakano S, Takeda l, Kumada T, Kiriyama S, Hisanaga Y. Massive hemorrhage from a Dieulafoy lesion in the caecum: Successful endoscopic management. Gastrointest Endosc 2000; 51:510-2.

29. Ma CK, Padd H, Pace EH, Szilagye E. Submucosal arterial malformation of colon with massive hemorrhage, report of a case. Dis Colon Rectum 1989; 2: 149-52.

30. Richard WO, Grove-Mahoney D, Williams LF. Hemorrhage from a Dieulafoy type ulcer of the colon: a new cause of lower gastrointestinal bleeding. Am Surg 1988: 54: 121-4.

31. Schmitt W, Lux G, Giedl J. Colonic hemorrhage from solitary submucosal vessel diagnosed by lower gastrointestinal Doppler-endoscopy. Endoscopy 1987; 19: 43-5.

32. Schmid KW, Pointer R, Feichtinger J. Exulceratio simplex of colon (letter). Endoscopy 1988; 20: 88-9.

33. Franko E, Chardovoyne R, Wise L. Massive rectal bleeding from a Dieulafoy's type ulcer of the rectum: a review of this unusual disease. Am J Gastroenterol 1991; 86: 1545-7.

34. Meister TE, Varilek GW, Mariano LS, Gates LK, Al-Tawid Y, de Villiers WJS. Endoscopic management of rectal Dieulafoy-like lesion; a cases series and review of literature. Gastrointest Endosc 1998;48: 302-5.

35. Rajendra T, Chung YFA, Ong HS. Rectal Dieulafoy's lesion: cause of massive lower gastrointestinal tract hemorrhage. Aust NZ Surg 2000; 70: 746-7.

36. Yeoh KG, Kang JY. Dieulafoy's lesion in the rectum. Gastrointest Endosc 1996; 43; 614-5.

37. Matsuoka J, Taniai K, Kojima K, Kenmotsu M, Takai K, Okabe T, et al. A case of rectal Dieulafoy's ulcer and successful endoscopic sclerotherapy. Acta Med Okayama 2000:54:281-3.

38. Abdulian JD, Santora MJ, Chen YK, Collen MJ. Dieulafoy-like lesion of the rectum presenting with exanguinating hemorrhage: Successful endoscopic therapy. Am J Gastroenterol 1993;88: 1939-41.

39. Toosoon JD, Marsano LS, Gates LK Jr. Pediatric rectal Dieulafoy's lesion. Am J Gastroenterol 1995:90:2232-3.

40. Harrison JD, Calatayud A, Thava VR, Kirby RM. Massive arterial bleeding from a single rectal vessel. Postgrad Med J 1997;73: 303-4.

41. Eguchi S, Maeda J, Tagushi H, Kanematsu T. Massive gastrointestinal bleeding from a Dieulafoy's-lesion of the rectum. J Clin Gastroenterol 1997; 50: 225-7.

42. Abdelmalek MF, Pokaj BA, Leighton JA, Rectal bleeding from a mucous fistula secondary to a Dieulafoy's lesion. J Clin Gastroenterol 1997:24: 259-61.

43. Tan MPC, Leong AFPK, Seow Choen F. Dieulafoy's lesion of the rectum. Techn Coloproctol 1997; 1: 146-7.

44. Nozoe T, Kitamura M, Matsumata T, Sugimachi K. Dieulafoy-like lesion of colon and rectum in patient with chronic renal failure on long term hemodialysis. Hepato- gastroenterology 1999; 46: 3121-3.

45. Amaro R, Petruff CA, Rogers Al. Rectal Dieulafoy's lesion; Report of a case and review literature. Dis Colon Rectum 1999;42:1339-41.

46. Kayali Z, Sangchantr W, Matsumoto B, Lower gastrointestinal bleeding secondary to Dieulafoy-like lesion of the rectum. J Clin Gastroenterol 2000; 30: 328-30.

47. Enns R. Dieulafoy's lesion of the rectum. A rare cause of lower gastrointestinal bleeding. Can J Gastroenterol 2001; 15:541-5.

48. Guy RJ, Ang ESW, Tan KC, Tsang CBS. Massive bleeding from a Dieulafoy like lesion of the rectum in a burn patient. Burns 2001; 27: 767-9.

49. Azimuddin K, Stasik JJ, Rosen L, Riether RD, Khubchandani IT. Dieulafoy's lesion of the anal canal: a new clinical entity. Dis Colon Rectum 2000; 43:423-6.

50. Yarze CJ, Schupp SL, Fritz HP. Hemorrhage relate to an anal Dieulafoy-like lesion. Am J Gastroenterol 2000; 95: 1593-4.

51. Marshall RJ, Leppard BJ. Ulceration of the lip associated with a caliber-persistent artery". Br J Dermatol 1985: 113:757-60.

52. Sweerts M, Nicholson AG, Goldstraw P, Corrin B. Dieulafoy's disease of the bronchus. Thorax 1995: 50: 697-8.

53. Miko LT, Thomazy VA. The caliber persistent artery of the stomach. A unifying approach to gastric aneurysm, Dieulafoy's lesion and submucosal arterial malformation. Hum Pathol 1988; 19:914-21.

54. Barlow TE, Bentley FH, Walder DN. Arteries, veins and arteriovenous anastomoses in human stomach. Surg Gynecol Obstet 1951; 6: 657-71.

55. Voth Quoted by Molnar P, Miko T. Multiple arterial caliber persistence resulting in hematomas and fatal rupture of gastric wall. Am J Surg Pathol 1982; 6: 83-6.

56. Fockens P, Meenan J, vanDullemen HH, Bolwerk CJH, Tytgat GNJ. Dieulafoy's disease: Endosonographic detection and endosonographic-guided treatment. Gastrointest Endosc 1996; 44: 437-42.

57. Juler GL, Labitzke HG, Lamb R, Allen R. The pathogenesis of Dieulafoy's gastric erosion. Am J Gastroenterol 1984;79:195-200.

58. Bakka A, Rosseland AR. Massive gastric bleeding from exulceratio simplex (Dieulafoy). Acta Chir Scand 1986; 152:285-8.

59. Chapman I, Lapi N. A rare cause of gastric hemorrhage. Arch Intern Med 1963; 112: 347-51.

60. Dieulafoy G. (Quoted by Veldhuyzen5) Exulceratio simplex. Bull Acad Med 1898; 39: 49-84.

61. Asaki S, Sato H, Nishimaru T, Ohkubo S, Yamagata R, Ito S, Saito Y, et al. Endoscopic diagnosis and treatment of Dieulafoy's ulcer. Tohoku J Exp Med 1988; 154: 135-41.

62. Yang CY. Recurrent Dieulafoy's lesion after surgical ligation. Am J Gastroenterol 1989: 84:1464-5.

63. Eidus LB, Rasuli P, Manion D, Heringer R. Caliber-persistent artery of stomach (Dieulafoy's vascular malformation). Gastroenterology 1990; 99: 1507-10.

64. Fallows GA, MacDonald K, Taylor H, Duerksen DR. Intestinal intussusception caused by jejunal Dieulafoy's lesion. Gastrointest Endosc 2000; 52: 107-9.

65. Parra-Blanco A, Takahashi A, Jerez PVM, Kojima T, Aksoz K, Hirihasa k. et al. Endoscopic management of Dieulafoy's lesion of stomach. A case study of 26 patients. Endoscopy 1997;29:834-9.

66. DyNM, Gostout CJ, Balm RK, Bleeding from endoscopically identified Dieulafoy lesion of proximal small intestine and colon. Am J Gastroenterol 1995;90:108-11.

67. Barbier P, Luder P, Triller J, Ruchli C, Hassler H, Stafford A. Colonic hemorrhage from solitary minute ulcer: report of three cases. Gastroenterology 1985;88: 1065-8.

68. Strong WR. Dieulafoy's disease-A distinct clinical entity. Aust NZ Surg 1984; 54: 337-9.

69. Broberg A, lhre T, Pyk E, Raaschove-Nielsen T. Exulceratio simplex as conceivable cause of massive gastric hemorrhage. Surg Gynecol Obstet 1982; 154: 186-8.

70. Boron B, Mobrahan S. Endoscopic treatment of Dieulafoy hemorrhage. J Clin Gastroenterol 1987;9: 518-20.

71. Gough MH. Submucosal arterial malformation of the stomach as the probable cause of recurrent severe hematemesis in 16-year-old girl. Br J Surg 1977;64: 522-4.

72. Vetto JT, Richman PS, Karinger K, Passaro E. Cirsoid aneurysm of jejunum. Arch Surg 1989; 124: 1460-2.

73. Rossi NP, Green EW, Pike JD. Massive bleeding of the upper gastrointestinal tract due to Dieulafoy's lesion. Arch Surg 1968;97:797-800.

74. Mortensen NJMcC, Mountford RD, Davies JD, Jeans WD. Dieulafoy's; a distinctive arteriovenous malformation causing massive gastric hemorrhage. Br J Surg 1983;70:76-

75. Eguchi S, Maeda J, Tagushi H, Kanematsu T. Massive gastrointestinal bleeding from Dieulafoy-like lesion of the rectum. J Clin Gastroenterol 1997;24: 262-3.

76. Sohendra N, Bohnacker S, Binmoeller KF. New and alternative hemostatic techniques. Surg Clin N Am 1997;7:641-56.

77. Yamamoto H, Koiwai H, Sekine Y, Sunada F, lino S, Ido K, et al. Colonoscopy in flowing water for lower GI bleeding: a reliable method for confirmation of bleeding points for endoscopic treatment. Gastrointest Endosc 2000; 52: 678-81.

78. Mackenzie JF. Push enteroscope. Surg Clin N Am 1999; 9:29-36.

79. Morris AJ, Mokhashi M, Straiton M, Murray L, Mackenzie JF. Push enteroscopy and heater probe therapy for small bowel bleeding. Gastrointest Endosc 1996; 44: 394-7.

80. Seensaen RN. The Sonde examination. Surg Clin N Am 1999; 9: 37-59.

81. Delmotte Js, Gay G, Houcke P, Mensard Y. Intraoperative endoscopy. Surg Clin N Am 1999; 9: 61-9.

82. Flickinger EG, Stanforth C, Sinar DR, MacDonald KG, Lannin DR, Gibson JH. Intraoperative video panendoscopy for diagnosing site of chronic intestinal bleeding. Am J Surg 1989;157:137-44.

83. Reddig ND, Rao VG. Laparosocopically assisted panenteroscopy for snare excission. Gastrointest Endosc 1996;44:208-9.

84. Matsushita M, Hajiro K, Takakuwa H, Fujikawa T, Laparoscopically assisted panenteroscopy for gastrointestinal bleeding of obscure origin. Gastrointest Endosc 1997; 46:474-5.

85. Gadenstafter M, Wetscher G, Crookes PE, Mason RJ, Schwab G, Pointer P. Dieulafoy's disease of large and small bowel. J Clin Gastroenterol 1998; 27: 169-72.

86. Wordehoff D, Gras H. Endoscopic haemostasis by injection therapy in high risk patient. Endoscopy 1982; 14; 196-9.

87. Hoffmann J, Beck H, Jensen HE. Dieulafoy's lesion. Surg Gynecol Obstet 1984; 159: 537-40.

88. Pointer R, Schwab G, Konigsrainer A, Dietze O. Endoscopic treatment of Dieulafoy's disease. Gastroenterology 1988;94:563-6.

89. Durham JD, Kumpe DA, Rothbarth LJ, Steigman GV. Dieulafoy disease: arteriographic findings and treatment. Radiology 1990; 174: 937-41.

90. Helliwell M, Irving JD. Hemorrhage from gastric artery aneurysm. Br Med J 1981:282:460-1.

91. Sherman L, Shenoy SS, Satchindanand SK, Neumann PR, Barrios GO, Peer RH. Arteriovenous malformation of the stomach. Am J Gastroenterol 1979; 72: 160-4.

92. Pollack R, Lipsky H, Goldberg RI. Duodenal Dieulafoy's lesion. Gastrointest Endosc 1993; 39: 820-2.

93. D'Imperio N. N-Butyl-2-Cyanoacrylate in the endoscopic treatment of Dieulafoy ulcer. Endoscopy 1995; 27:216.

94. Loperfido S. Endoscopic hemostasis of gastric bleeding from Dieulafoy' s ulcer with histoacryl. Endoscopy 1989:21:199-200.

95. Ruteerts P, Geboes K, Vantrappen G. Tissue damage produced by hemostatic injection. Gastrointest Endosc 1986;32: 179.

96. Rajcopal C, Lessels A, Palmer KR. Mechanism of action of injection for bleeding peptie ulcer. Br J Surg 1992;79:782-4

97. Chester JF, Hurley PR. Gastric necrosis: a complication of endoscopic sclerosis of bleeding peptic ulcer. Endoscopy 1990;22:287.

98. Lev J, Khakoo s, Barton R, Vicary R, Fatal injection sclerotherapy of bleeding peptic ulcer. Lancet 1991;337:540.

99. Vallieres E, Jamieson C, Haber GB, Mackenzie RL. Pancreatico-duodenal necrosis after endoscopic injection of cyanoacrylate to treat a bleeding duodenal ulcer: a case report. Surgery 1989; 106: 901-3.

100. Bedford RA, Stock RV, Sivak MV, Chung RS, VanDam J. Gastric perforation after endoscopic treatment of a Dieulafoy's lesion. Am J Gastroenterol 1992; 87: 244-7.

101. Bech-Knudsen F, Toftgaard C, Exulceratio simplex, Surg Gynecol Obstet 1993; 176: 139-43.

102. Kumar P, Fleischer DE. Thermal therapy of gastro intestinal bleeding. Surg Clin N Am 1997; 7:593-609.

103. Jensen DM. Heat probe for hemostasis of bleeding peptic ulcer: Techniques and results of randomized controlled trials. Gastrointest Endosc 1990; 36: 842-9.

104. Papp JP. Monopolar and electrohydrothermal treatment of upper gastrointestinal bleeding. Gastrointest Endosc 1990:36: S34-S37.

105. Consensus development panel. Consensus statement on therapeutic endoscopy and bleeding ulcer, Gastrointest Endosc 1990; 36: 562.

106. Brown GR, Harford WV, Jones WF. Endoscopic band ligation of an actively bleeding Dieulafoy's lesion. Gastrointest Endosc 1994; 40: 501-3.

107. McGrath K, Mergener K, Branch s, Endoscopic band ligation of Dieulafoy's lesion. Am J Gastroenterol 1999; 94: 1087-90.

108. Squillace SJ, Johnson DA, Sanoski RA. The endosonographic appearance of a Dieulafoy's lesion, Am J Gastroenterol 1994;89:276-7.

109. Jaspersen D, Gaster CB, Koerner TH, Hammar CH. Doppler controlled injection treatment of Dieulafoy's disease. J Gastroenterol Hepatol 1993; 8; 267-9.

110. Rebeiro PR, Vozquez-Sequeiros E, Wiersema CJ. Doppler EUS-guided treatment of gastric Dieulafoy's lesion. Gastrointest Endosc 2001; 53: 807-9.

111. Jespersen D. Dieulafoy's disease controlled by Doppler ultrasound endoscopic treatment. Gut 1993; 4: 857-8.

112. Grisendi A, Lonardo A, Casa DG, Frazzoni M, Pulvirenti M, Ferrari M, et al. Combined endoscopic and surgical management of Dieulafoy vascular malformation. J Am Coll Surg 1994; 179: 182-6.

113. Bouillot JL, Aubertin JM, Fornes P, Patite JP, Alexandre JH. Dieulafoy's ulcer: combined endoscopic and laparoscopic treatment. Endoscopy 1996; 28: 394-5.

114. Karanflian RG, Yang HK, Gendler S. Resection of Dieulafoy's lesion by a combined endoscopic and laparoscopic approach. J Laparoendosc Surg 1996; 6: 345-8.

115. Douard R, Wind P, Panis Y, Marteau P, Bouhuik Y, Cellier C, et al. Intraoperative enteroscopy for diagnosis and management of unexplained gastrointestinal bleeding. Am J Surg 2000; 180: 181-4.

116. Swain CF, Storey DW, Bown SG, Heath J, Mills TW, Salmon DR, et al. Nature of the bleeding vessels in recurrent bleeding gastric ulcer. Gastroenterology 1986; 90: 595-608.

117. Raijman I, Haber GB. Small intestine Dieulafoy lesion: or "Dieulaclip", Endoscopy 1995; 27:215.

Downloads

Published

2002-09-30

How to Cite

1.
Treesaranuwattana S, Khemtai C. Dieulafoy’s Lesion: Pathology, Diagnosis and Treatment. Thai J Surg [Internet]. 2002 Sep. 30 [cited 2024 Mar. 29];23(3):87-96. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/243072

Issue

Section

Original Articles