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Upper gastrointestinal haemorrhage
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Dieulafoy’s lesion in the stomach. Recommended treatment is thermal ablation.
Dieulafoy’s lesion is an important cause of upper gastrointestinal haemorrhage and may account for up to 5% of acute haemorrhages.1 Dieulafoy et al described it in 1897 as exulceratio simplex, cirsoid aneurysm.1 The histological appearance is characteristic; a relatively large calibre artery that lies close to the mucosal surface, likely as a congenital anomaly. Most Dieulafoy lesions are diagnosed by their endoscopic features. The features are arterial bleeding or non-bleeding visible vessel stigmata, all with normal surrounding mucosa. However, this lesion is commonly missed as illustrated by our case and the initial endoscopy is diagnostic in only 63% of cases.1 It is potentially life threatening and massive haemorrhage can occur with erosion of the mucosa and arterial wall.
The study by Norton et al suggests endoscopic haemostasis was achieved in 94% of cases.1 Various endoscopic haemostatic methods have been advocated
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- Upper gastrointestinal haemorrhage
- C H Lim and D M Chalmers
Postgrad. Med. J. 2004 80: 492.[Extract] [Full Text] [PDF]
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