Dieulafoy-Ulcus

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

Epidemiology

  • contributes to ~1.5% of all acute gastrointestinal bleeding
  • male : female 2:1
  • can occur at any age but presents more commonly in older patients

Clinical presentation

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

Pathology

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

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 GI tract entirely, e.g. bronchus

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

Treatment and prognosis

Endoscopic treatment is the treatment of choice and has reported success rate over 90% . 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) , another French surgeon in 1898 .

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