Dieulafoy lesion: A rare cause of bleeding in upper gastrointestinal bleeding cases

Abstract

Dieulafoy's lesion is an uncommon, recurrent but also important cause of gastrointestinal bleeding, and can present some difficulties in diagnosis. While the great majority of Dieulafoy's lesions are located in the stomach within 6-10 cm of the gastroesophageal junction, occurrence of lesions in other parts of the gastrointestinal tract is rare. Endoscopic band ligation and endoscopic sclerotherapy are the treatment modalities to control bleeding. We report three cases with recurrent massive gastrointestinal bleeding from Dieulafoy's lesion, who were finally diagnosed after recurrent endoscopic investigations. Bleeding was controlled with endoscopic sclerotherapy injection in one of the three cases.

Keywords

• Dieulafoy's lesions, upper gastrointestinal bleeding, endoscopic treatment of Dieulafoy's lesion

Dieulafoy lezyonu olgularımızın endoskopik bulguları ve endoskopik tedavi sonuçları

Öz

Dieulafoy lezyonu tekrarlayan ve tanısının konmasında zorluklar yaşanan nadir fakat aynı zamanda önemli bir üst gastrointestinal kanama nedenidir. Sıklı kla özofagogastrik bileşkeye 6-10 cm mesafede midede yer alsa da, gastrointestinal sistemin diğer kısımlarında daha az sıklıkla lokalizedir. Endoskopik bant ligasyon ve endoskopik skleroterapi kanama kontrolunde oldukça başarılıdır.Retrospektif değerlendirmede tekrarlayan massif kanama ile hastanemize başvuran 3 hastada ancak tekralayan endoskopik incelemeler sonrası tanı konuldu. Dieulafoy lezyonu olan 3 hastamızdan ikisinde endoskopik bant ligasyonu ile diğer hastada ise endoskopik skleroterapi injeksiyonu ile kanama kontrolu sağlandı.

Anahtar Kelimeler

• Dieulafoy lezyonu, üst gastrointestinal kanama, endoskopik tedavi

Kaynakça

1. Mcgrath K, Mergener K, Branch S. Endoscopic band ligation of dielula- foys lesion: Report of two cases and, review of the literature. Am J Gas- troenterol 1999; 94:1087-90.
2. Norton ID, Peterson BT, Sorbi D, et al. Management and long term prog- nosis of dieulafoy lesion. Gastrointest Endosc 1999;50:762-7.
3. Ertem S, Aydın A, Batur Y, et al. Dieulafoy vasküler malformasyonuna bağlı bir masif hematemez vakası. T Klin Gastroenterohepatoloji 1994:164-6.
4. Canbaz H, Korkut M, Alkanat M, et al. Uçar Y, Kara E. Dieulafoy vaskü- ler malformasyonu, gastrointestinal sistemin nadir kanama nedenlerin- den biri. Turk J Gastroenterol 1999:10;157-60.
5. Koyuncu A, Lice H, Arıkan S, et al. Masif üst gastrointestinal sistem ka- namasına neden olan Dieulafoy’s Hastalığı. Ulus Travma Derg 2003:9;140-2.
6. Yılmaz U, Özütemiz Ö, Ersöz G, et al. Seyrek görülen bir üst gastroin- testinal kanama nedeni: Dieulafoy lezyonu. Türk Gastroenteroloji Dergi- si 1988;2:146-9.
7. Juler GJ, Labitzke HG, Lamb R, et al. The pathogenesis of Dieulafoy’s gastric erosion. Am J Gastroenterol 1984;79:195-200.
8. Baettig B, Haecki W, Lammer F, et al. Dieulafoy’s disease: Endoscopic treatment and follow up. Gut 1993;34:1418-21.

9. Reilly HF, Al-Kawas FH. Dieulafoy’s lesion. Gastrointest Endosc 1987;33:38-9.
10. Veldhuyzen van Zanten SJ, Bartelsman JF, Schipper ME, et al. Recurrent massive haematemesis from Dieulafoy vascular malformations a review of 101 cases. Gut 1986;27:213-22.
11. Rosai J. Gastrointestinal Tract. In: Rosai J. Rosai and Ackerman’s Surgi- cal Pathology. 9th ed. Philadelphia: Elsevier; 2004: 656.
12. Miko TL, Thomazy VA. Caliber persistent artery of the stomach. Hum Pathol 1988;19:914-21.
13. Juler GL, Labitzke HG, Lamb R, Allen R. The pathogenesis of Dieulafoy’s gastric erosion. Am J Gastroenterol 1984;79:195-200.
14. Hoffmann J, Beck H, Jensen HE. Dieulafoy’s lesion. Surg Gynecol Obstet 1984;159:537-40.
15. Chan AY, Ramsey WH. Recurrent upper gastrointestinal bleeding due to the Dieulafoy’s lesion. Conn Med 2000;64:139-41.
16. Lee YT, Walmsley RS, Leong RWL, Sung JJY. Dieulafoy’s lesion. Gastro- intest Endosc 2003:58;236-43.
17. Campbell DR, Dixon AY. Dieulafoy’s lesion. Gastrointest Endosc 2000:51;466.
18. Mc Grath K, Mergener K, Branch S. Endoscopic band ligation of Dieula- foy’s lesion: Report of two cases and review of the literature. Am J Gas- troenterol 1999:94;1087-90.
19. Lin HJ, Lee FY, Tsai YT, et al. Therapeutic endoscopy for Dieulafoy’s di- sease. J Clin Gastroenterol 1989;11:507-10.
20. Chaer RA, Helton WS. Dieulafoy’s disease. J Am Coll Surg 2003;196:290-6.
21. Skok P. Endoscopic hemostasis in exulceratio simplex-Dieulafoy’s disea- se hemorrhage: A review of 25 cases. Endoscopy 1998:30;590-4.
22. Stark ME, Gostout CJ, Balm RK. Clinical features and endoscopic mana- gement of Dieulafoy’s disease. Gastrointest Endosc 1992;38:545-50.
23. Goldenberg SP, DeJuca VAJ, Marignani P. Endoscopic treatment of Di- eulafoy’s lesion of the duodenum. Am J Gastroneterol 1990;85:452-4.
24. Al-Kawas FH, O’Keefe J. Nd YAG laser treatment of a bleeding Dieula- foy’s lesion. Gastrointest Endosc 1987;33:38-9.
25. Pointner R, Schwab G, Konigsrainer A, et al. Endoscopic treatment of Di- eulafoy’s disease. Gastroenterology 1988;94:563-6.
26. Asaki S, Sato H, Nishimura T, et al. Endoscopic diagnosis and treatment of Dieulafoy’s ulcer. Tohoku J Exp Med 1988;154:135-41.
27. Loperfido S. Endoscopic hemostasis of gastric bleeding from Dieulafoy’s ulcer with histoacryl. Endoscopy 1989;21:199-200.
28. Brown GR, Harford WV, Jones WF. Endoscopic band ligation of an ac- tively bleeding Dieulafoy lesion. Gastrointest Endosc 1994;40:501-3.
29. Murray KF, Jennings RW, Fox VL. Endoscopic band ligation of a Dieu- lafoy lesion in the small intestine of a child. Gastrointest Endosc 1996;44:336-9.
30. Gerson LB, Yap E, Slosberg E, et al. Endoscopic band ligation for acti- vely bleeding Dieulafoy’s lesions. Gastrointest Endosc 1999;50:454-5.
31. Veldhuyzen van Zanten SJ, Bartelsman JF, Schipper ME, et al. Recurrent massive haematemesis from Dieulafoy vascular malformations-a review of 101 cases. Gut 1986;27:213-22.