Dieulafoy’s Lesion – Causes, Symptoms and Treatment
is a condition which is closely associated with gastrointestinal bleeding. It is caused by the rupture and erosion of a large blood vessel or arteriole in the stomach wall. It is a rare condition and is known to cause less than 5 % of all stomach bleeds. However, it has the potential of causing gastric hemorrhage if untreated. It is not inherited and is more of a developmental disorder. It is not often that this type of lesion causes gastrointestinal bleeding and hence, diagnosis may be difficult.
Dieulafoy’s lesion occurs twice as much in men than women. Generally patients with hypertension, chronic kidney disease, cardiovascular disease and diabetes get it more often.
How Dieulafoy’s Lesion is caused?
It is characterized by a large bulging single blood vessel in the submucosa (connective tissue in the lining of the stomach). Unlike other capillaries, it does not undergo any branching and extends and widens in diameter. The blood vessel or arteriole protrudes through a tear in the submucosa. The tear occurs by erosion of the connective tissue due to the constant pressure of the bulging and pulsating blood vessel. This occurs mostly in the upper part of the stomach, within 6 cms of the gastrophageal junction (the meeting point of the esophagus and stomach). The blood vessel may rupture and cause massive gastrointestinal bleeding. It isn’t a chronic condition and caused by an abnormality in the development of the arteriole.
– This lesion is difficult to be diagnosed because of the intermittent pattern of bleeding.However, some symptoms generally follows:
- Recurrent and often intense blood vomiting or haematemesis along with melena (black tarry stools). In 51% of patients this symptom is found.
- Blood vomiting or haematemesis may be present by itself without any other symptom of bloody and tarry stools. This occurred among 28% of patients.
- In 18% of patients only black tarry stools or melena was present.
- Anaemia often onsets from the loss of blood.
Treatment of Dieulafoy’s Lesion
Earlier an open surgery was the only option available. However the discovery of the endoscopic procedure have made things easy. This particular lesion can very well be treated with intra operative endoscopy in which a complete visualization of the affected capillary is coupled with precise surgical removal of the lesion.