Related Subjects:
|Upper Gastrointestinal Bleed
|Oesophageal Variceal Bleeding
|Dieulafoy Lesion
|Mallory-Weiss Tear
|Gastric Cancer
|Peptic Ulcer Disease
|Oesophagogastroduodenoscopy (OGD/EGD)
|Hereditary Haemorrhagic Telangiectasia
|Hypovolaemic or Haemorrhagic Shock
💉 Dieulafoy’s lesion causes ~1–2% of acute GI bleeds, but is likely under-recognised rather than rare.
⚠️ The bleeding is arterial and can be massive, recurrent, and life-threatening.
📖 About
- 🧑⚕️ First described by Georges Dieulafoy in 1898 – 3 fatal UGIB cases in young men.
- 📊 Accounts for 1–2% of upper GI bleeds (UGIB).
- 🩸 Source: an aberrant, dilated, submucosal artery that remains unusually large (1–3 mm).
- 📍 Most often located on the lesser curvature of the stomach.
👤 Typical Patient Profile
- 👴 Elderly (M:F = 2:1).
- 🏥 Often hospitalised, with multiple comorbidities.
- 💊 History of NSAIDs, aspirin, or anticoagulants.
- 🚫 No previous GI pathology.
- ⚡ Presents with sudden, massive GI bleeding ± recurrence.
🩺 Clinical Presentation
- 🤮 Massive haematemesis.
- 🪦 Melaena.
- 💔 Shock from haemorrhage.
- 🩸 Iron-deficiency anaemia if recurrent slow bleeding.
🔎 Investigations
- 🧪 FBC/U&E: Anaemia, raised urea (UGIB), clotting screen.
- 📹 OGD: Gold standard – tiny (<3 mm) mucosal defect with arterial spurting or pulsatile bleeding, often with normal surrounding mucosa.
- 🩻 Angiography: If endoscopy fails – shows tortuous ectatic artery (often left gastric), no early venous return.
- 🩷 Tagged red cell scan: Can help localise bleeding if endoscopy inconclusive.
🛠️ Management
- 🆘 Resuscitation: ABC, IV access, fluids, blood transfusion.
- 🔬 Endoscopic therapy (first-line):
- 🔥 Thermal: electrocoagulation, argon plasma coagulation.
- 💉 Injection: epinephrine, sclerosants.
- 📎 Mechanical: band ligation, haemoclip (often most effective).
- 📡 EUS: Can confirm aberrant vessel and success of ablation.
- ⛔ Reverse anticoagulation / stop antiplatelets if safe.
- 🩻 Angiographic embolisation: Alternative if endoscopy fails (risk of ischaemia).
- 🔪 Surgery: Last resort – wedge resection or under-running of vessel.
📚 References
