Dieulafoy-Ulcus

Short gastric
artery embolization in Dieulafoy\"s lesion. Selective angiogram of splenic artery reveals ectatic and tortuous short gastric artery, with the trajectory abutting the gastric clips.
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Angio-CT
diagnosis of small bowel acute haemorrhage from a Dieulafoy’s lesion. A blush of contrast within the wall of a proximal small bowel loop (left abdominal flank) is visualized. A small liver cyst is also seen.
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Angio-CT
diagnosis of small bowel acute haemorrhage from a Dieulafoy’s lesion. The blush of contrast within the wall of a proximal small bowel loop (left abdominal flank) is increasing. The colon was filled with spontaneously dense material compatible with bleeding contents (not shown).
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Angio-CT
diagnosis of small bowel acute haemorrhage from a Dieulafoy’s lesion. A 1 cm-pseudopolypoid lesion with surface hyperaemia and fresh adherent clot was discovered in the middle jejunum. No other abnormality was seen endoscopically.
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Massive lower
gastrointestinal bleeding from jejunal diverticulum with an occult Dieulafoy’s lesion. Coronal (upper) and axial (lower) images. Diverticulum (white arrow) originating in the jejunum wall (*), with stranding of the adjacent fat (white arrowhead). There was no hyperattenuating material within the diverticulum lumen.
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Massive lower
gastrointestinal bleeding from jejunal diverticulum with an occult Dieulafoy’s lesion. Coronal (upper) and axial (lower) images. Swirling jet of contrast material (black arrow) within the lumen of the diverticulum (white arrow). A collapsed inferior cava vein indicates hypovolaemia (white arrowhead).
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Massive lower
gastrointestinal bleeding from jejunal diverticulum with an occult Dieulafoy’s lesion. Coronal (upper) and axial (lower) images. The amount of intraluminal contrast increases in diverticular (black arrowhead) and jejunal (black arrow) lumen in comparision with arterial phase. Hyperattenuating material in the colon suggests blood (white arrowhead).
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Arteriographic
diagnosis and treatment of gastric Dieulafoy lesion. Abdominal CTA showing voluminous arterial hypertrophy of the gastric fundus, communicating with the spleen by way of the short gastric arteries.
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Arteriographic
diagnosis and treatment of gastric Dieulafoy lesion. Selective arteriography of the left gastric artery with a Simmons 1 4Fr catheter and a 2.9 Fr microcatheter shows large arterial hypertrophy of the gastric fundus communicating with the spleen by the short gastric arteries.
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Radiopaedia • CC-by-nc-sa 3.0 • de

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 .

Siehe auch:
Assoziationen und Differentialdiagnosen zu Dieulafoy-Ulcus:
Magenulkus
 
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