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Qiu J, Xia Y, Ouyang Q, Wang L, Ding R, Huang Y, Yang Z, Shu X, Pan X, Zhang Y. Forrest-type IIb increases the risk of rebleeding after endoscopic treatment in patients with Dieulafoy's lesion of the upper gastrointestinal tract. Ann Med 2025; 57:2478645. [PMID: 40083167 PMCID: PMC11912250 DOI: 10.1080/07853890.2025.2478645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/09/2025] [Accepted: 02/11/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a rare cause of nonvariceal upper gastrointestinal bleeding (NVUGIB) and represents a significant clinical challenge. This research aimed to identify the potential risk factors contributing to DL rebleeding after endoscopic hemostasis, including patient characteristics and laboratory and endoscopic findings such as the Forrest classification. METHODS This retrospective study encompassed patients diagnosed with upper gastrointestinal DL who received standard endoscopic hemostasis between April 2007 and June 2024. Patients included in this study were categorized into the rebleeding and non-rebleeding groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for DL rebleeding. RESULTS Of the 272 patients included in this study, rebleeding occurred in 46 (16.9%). Multivariate logistic regression demonstrated that Forrest-type IIb lesions (odds ratio [OR] 3.86, 95% confidence intervals [CI] 1.16-12.83, p = 0.027) and less experienced endoscopists (OR 3.74, 95%CI 1.82-7.66, p < 0.001) were recognized as independent risk factors for rebleeding of DL in the upper gastrointestinal tract after endoscopic hemostasis. Compared with the non-rebleeding group, patients in the rebleeding group had received more transfusion units, a longer length of hospitalization, and higher rates of intensive care unit (ICU) transfer, embolization or surgery, and mortality (p < 0.005). CONCLUSION Forrest-type IIb lesions and less experienced endoscopists were independent risk factors for DL rebleeding in the upper gastrointestinal tract after endoscopic hemostasis. More attention should be given to DL presenting as Forrest-type IIb, as rebleeding is often closely associated with a worse clinical prognosis.
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Affiliation(s)
- Jiayu Qiu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yanhong Xia
- Department of Gastroenterology, ShangRao GuangXin District People’s Hospital, Shangrao, Jiangxi, China
| | - Qingping Ouyang
- Department of Gastroenterology, Central People’s Hospital of Ji’an, Ji’an, China
| | - Liping Wang
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Ruiying Ding
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yang Huang
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zhenzhen Yang
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiaolin Pan
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yanxia Zhang
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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Sandhu S, Gross J, Barkin JA. Small Bowel Bleeding Due to Vascular Lesions: Pathogenesis and Management. Curr Gastroenterol Rep 2025; 27:37. [PMID: 40481967 PMCID: PMC12145302 DOI: 10.1007/s11894-025-00989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2025] [Indexed: 06/11/2025]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive review and recent updates in the understanding of the pathogenesis, diagnosis, and management of small bowel vascular lesions. RECENT FINDINGS Recent terminology has shifted from "obscure GI bleeding" to "small bowel bleeding", with the former reserved for cases when the source of bleeding is not detected despite a thorough evaluation of the entire GI tract, including the small bowel. Recent diagnostic advances including imaging, video capsule endoscopy (VCE), and deep enteroscopy have allowed for the identification of most small bowel bleeding sources. The incidence of small bowel bleeding remains a relatively uncommon event. Vascular lesions remain the most common etiology of small bowel bleeding, with angiodysplasia representing the majority of vascular small bowel lesions. Standard therapeutic approach includes adequate resuscitation and endoscopic evaluation, with consideration of medical therapy (including somatostatin analogues and antiangiogenic agents), endoscopic interventions, radiologic procedures, or surgical therapy in select patients.
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Affiliation(s)
- Sunny Sandhu
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Leonard M. Miller School of Medicine at the University of Miami, 1120 NW 14 th Street, Clinical Research Building, Suite 1188 (D-49), Miami, FL, 33136, USA
| | - Jonathan Gross
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Leonard M. Miller School of Medicine at the University of Miami, 1120 NW 14 th Street, Clinical Research Building, Suite 1188 (D-49), Miami, FL, 33136, USA
| | - Jodie A Barkin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Leonard M. Miller School of Medicine at the University of Miami, 1120 NW 14 th Street, Clinical Research Building, Suite 1188 (D-49), Miami, FL, 33136, USA.
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González Zambrana RJ, Hernández Reyes KY, Valladares MJ, Pereira Santana CG. Massive gastrointestinal bleeding due to a Dieulafoy jejunal lesion: a case report. Int J Surg Case Rep 2025; 131:111431. [PMID: 40378420 DOI: 10.1016/j.ijscr.2025.111431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 04/29/2025] [Accepted: 05/10/2025] [Indexed: 05/18/2025] Open
Abstract
INTRODUCTION Jejunal Dieulafoy lesions is a rare cause of gastrointestinal bleeding. Most cases are asymptomatic and require difficult surgical approaches even as endoscopic advancements have become available. CASE PRESENTATION We describe the case of a 19-year-old female who suffered a massive lower gastrointestinal bleeding, was hemodynamically unstable and needed blood transfusions. We performed an intraoperative enteroscopy which revealed a jejunal Dieulafoy lesion and proceeded to surgically resect and repair it by anastomosis. There were no negative outcomes during the hospitalization. CLINICAL DISCUSSION Surgery is required in less than 5 % of such cases, when bleeding cannot be controlled by endoscopic approach, angiography or when these methods are not available. CONCLUSION It is important to be aware of this lesion as a cause of gastrointestinal bleeding and differentiate it from other causes.
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Affiliation(s)
- Roberto José González Zambrana
- General Surgery Department, Hospital Escuela Oscar Danilo Rosales Argüello, Ministerio de Salud Nicaragua, Nicaragua; Hospital Escuela Oscar Danilo Rosales Argüello, First Av. East. Barrio el Sagrario, C.P. 21000 León, Nicaragua.
| | - Katerin Yaritza Hernández Reyes
- General Surgery Department, Hospital Escuela Oscar Danilo Rosales Argüello, Ministerio de Salud Nicaragua, Nicaragua; Hospital Escuela Oscar Danilo Rosales Argüello, First Av. East. Barrio el Sagrario, C.P. 21000 León, Nicaragua
| | - Marion José Valladares
- Medicine Faculty, Universidad Nacional Autónoma de Nicaragua, Central Park 175 mts North, C.P. 2100 León, Nicaragua
| | - Cristian Geovanny Pereira Santana
- General Surgery Department, Hospital Escuela Oscar Danilo Rosales Argüello, Ministerio de Salud Nicaragua, Nicaragua; Hospital Escuela Oscar Danilo Rosales Argüello, First Av. East. Barrio el Sagrario, C.P. 21000 León, Nicaragua
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Nagesh VK, Pulipaka SP, Bhuju R, Martinez E, Badam S, Nageswaran GA, Tran HHV, Elias D, Mansour C, Musalli J, Bhattarai S, Shobana LS, Sethi T, Sethi R, Nikum N, Trivedi C, Jarri A, Westman C, Ahmed N, Philip S, Weissman S, Weinberger J, Bangolo AI. Management of gastrointestinal bleed in the intensive care setting, an updated literature review. World J Crit Care Med 2025; 14:101639. [DOI: 10.5492/wjccm.v14.i1.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/08/2024] [Accepted: 12/02/2024] [Indexed: 12/11/2024] Open
Abstract
Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.
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Affiliation(s)
- Vignesh K Nagesh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sai Priyanka Pulipaka
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ruchi Bhuju
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Emelyn Martinez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shruthi Badam
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gomathy Aarthy Nageswaran
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Hadrian Hoang-Vu Tran
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Daniel Elias
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Charlene Mansour
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jaber Musalli
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sanket Bhattarai
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Lokeash Subramani Shobana
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Tannishtha Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ritvik Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Namrata Nikum
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Chinmay Trivedi
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Amer Jarri
- Department of Pulmonology and Critical Care, HCA Florida Bayonet Point Hospital, Hudson, FL 34667, United States
| | - Colin Westman
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Nazir Ahmed
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Shawn Philip
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jonathan Weinberger
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Ayrton I Bangolo
- Department of Hematology & Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
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Bhattarai S, Algarin Perneth S, Padilla Zambrano H, Leggett CL. Clinical approach to the diagnosis and management of small bowel bleeding. Minerva Med 2025; 116:31-42. [PMID: 39328002 DOI: 10.23736/s0026-4806.24.09361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
The diagnosis and management of small bowel bleeding (SBB) can be a clinical challenge. Advances in video capsule endoscopy, balloon-assisted enteroscopy, and multiphasic computed tomography allow for localization and therapeutic intervention. Etiologies of SBB including vascular, neoplastic, and inflammatory conditions are associated with age and comorbidities. The present review highlights terminologies that describe SBB, provides a differential diagnosis for bleeding etiologies, and summarizes a clinical approach to managing this condition.
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Affiliation(s)
- Sanket Bhattarai
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Cadman L Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA -
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Tran V, Olavarria-Bernal D, Swarna S, Mittal N. The Silent Bleeder: A Case of Recurrent Hemorrhage From a Dieulafoy's Lesion. Cureus 2025; 17:e79000. [PMID: 40091976 PMCID: PMC11910965 DOI: 10.7759/cureus.79000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2025] [Indexed: 03/19/2025] Open
Abstract
Dieulafoy's lesion is a rare but potentially life-threatening cause of gastrointestinal (GI) bleeding. We report the case of a 75-year-old woman with a history of transient ischemic attack (TIA), hypertension, chronic obstructive pulmonary disease (COPD), and non-small cell lung cancer (NSCLC), who presented with dizziness, nausea, and abdominal pain. Initial evaluations revealed progressive anemia, though no source of bleeding was identified on imaging, nor were there external signs of bleeding. Endoscopy later confirmed an actively bleeding Dieulafoy's lesion, which was successfully treated with hemoclips. This case highlights the diagnostic challenges of Dieulafoy's lesion due to its intermittent bleeding and nonspecific presentation. Endoscopic intervention remains the first-line treatment, and early recognition is crucial to prevent life-threatening complications.
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Affiliation(s)
- Vivie Tran
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Subash Swarna
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Neha Mittal
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
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Farag M, Diaz Y, Patel H. Colonic Dieulafoy Lesion as a Rare Cause of Lower Gastrointestinal Bleeding. Case Rep Gastroenterol 2025; 19:52-56. [PMID: 39897406 PMCID: PMC11785396 DOI: 10.1159/000542790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/18/2024] [Indexed: 02/04/2025] Open
Abstract
Introduction Dieulafoy lesion is one of the most under-recognized sources of gastrointestinal (GI) bleeding (GI), typically manifesting as acute upper gastrointestinal bleeding; endoscopy is usually the first diagnostic and therapeutic modality utilized to handle these lesions by employing a variety of procedures. Case Report This is a case of an 81-year-old female who was being assessed after experiencing repeated bouts of melena with hemoglobin drop. The patient had multiple comorbidities but no history of gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) revealed only Erythematous duodenopathy without active bleeding; the initial colonoscopy revealed a large amount of blood without identifying the source of bleeding; a second colonoscopy revealed classic Dieulafoy lesions in the splenic flexure, which were injected and clipped, and the bleeding ceased. Conclusion Dieulafoy lesions are most frequently found in the stomach and gastroesophageal junction, but they have also been documented in other parts of the gastrointestinal tract. In this particular instance, the lesions were identified in the colon, which is an unusual location for them, and they were treated endoscopically by clipping and injecting. In conclusion, colonic Dieulafoy lesions, although rare, have the potential to cause life-threatening bleeding and should be included in the differential diagnosis of lower gastrointestinal bleeding.
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Affiliation(s)
- Mohamed Farag
- Internal Medicine Department, Bronxcare HealthSystem, Bronx, NY, USA
| | - Yordanka Diaz
- Internal Medicine Department, Bronxcare HealthSystem, Bronx, NY, USA
| | - Harish Patel
- Internal Medicine Department, Bronxcare HealthSystem, Bronx, NY, USA
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Alkhanjar MM, Hasan HA, Albanna SH, Almutawa RS, Alsudairy N. Dieulafoy's Lesion: A Rare and Elusive Cause of Massive Upper Gastrointestinal Bleeding Managed With Endoscopic Therapy. Cureus 2025; 17:e77206. [PMID: 39925567 PMCID: PMC11807404 DOI: 10.7759/cureus.77206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2025] [Indexed: 02/11/2025] Open
Abstract
A Dieulafoy's lesion is a rare vascular anomaly that can cause massive upper gastrointestinal bleeding. It often presents with hematemesis and requires prompt diagnosis and intervention. We report a case of a 54-year-old male patient with hypertension and diabetes mellitus who presented to the emergency department with hematemesis. After the initial resuscitation, an esophagogastroduodenoscopy revealed a pulsatile submucosal artery in the proximal stomach, consistent with a Dieulafoy's lesion. No evidence of peptic ulcer disease, gastric varices, or malignancy was noted. Endoscopic hemostasis was achieved using an epinephrine injection followed by thermal coagulation. The patient's hospital course was uncomplicated, with no further bleeding episodes. Computed tomography angiography confirmed the diagnosis and ruled out other potential sources of bleeding. The patient was discharged on a proton pump inhibitor regimen and scheduled for a follow-up endoscopy in six weeks, which showed complete mucosal healing. A Dieulafoy's lesion remains a challenging diagnosis due to its subtle presentation and requires a high index of suspicion, especially in patients with unexplained gastrointestinal bleeding. Endoscopic therapy is highly effective in managing this condition and, when promptly addressed, results in excellent outcomes. This case highlights the importance of early recognition and intervention, contributing to the growing body of evidence supporting the role of endoscopy in the management of Dieulafoy's lesion.
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Affiliation(s)
- Mustafa M Alkhanjar
- College of Medicine, Southeast University, Nanjing, CHN
- General Practice, Dammam Medical Complex, Dammam, SAU
| | - Hawra A Hasan
- College of Medicine, Mansoura University, Mansoura, EGY
- General Practice, Dammam Medical Complex, Dammam, SAU
| | - Shaikha H Albanna
- College of Medicine, Southeast University, Nanjing, CHN
- General Practice, Dammam Medical Complex, Dammam, SAU
| | - Rawah S Almutawa
- General Practice, Ibn Al-Nafees Hospital, Manama, BHR
- General Practice, Dammam Medical Complex, Dammam, SAU
| | - Njood Alsudairy
- Radiology, Jeddah Second Health Cluster, Jeddah, SAU
- General Practice, Dammam Medical Complex, Dammam, SAU
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Blázquez Ávila V, Espinel Diez J, Jiménez Palacios M. Jejunal Dieulafoy's lesion as a cause of difficult-to-manage obscure gastrointestinal bleeding. Combined endoscopic treatment. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:709. [PMID: 38235668 DOI: 10.17235/reed.2024.10176/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Dieulafoy's lesion (DL) is an uncommon vascular malformation-an aberrant, dilated submucosal arteriole (1-3 mm thick, 10 x nv). It runs near the mucosal surface and protrudes, and may potentially induce gastrointestinal bleeding (GIB). It usually originates in the stomach (upper lesser curvature), with endoscopy being the diagnostic, therapeutic modality of choice. Jejunal DL (JDL) is a rare cause of obscure GIB (OGIB) that is challenging for endoscopists and threatens patient lives. Other diagnostic techniques such as Tc99m-labeled red blood cell scintigraphy, well established in the classic armamentarium for OGIB diagnosis, cannot overcome endoscopic procedures. We report the case of a patient with OGIB secondary to an exceptionally located Dieulafoy's lesion who underwent combined endoscopic treatment.
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Tripathi S, Narayanagowda R, Das SAP, Jain S, Nundy S. Sudden-onset gastrointestinal bleeding in a young adult: diagnostic and therapeutic challenges of a Dieulafoy's lesion in the jejunum. Surg Case Rep 2024; 10:269. [PMID: 39572422 PMCID: PMC11582246 DOI: 10.1186/s40792-024-02064-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 11/06/2024] [Indexed: 11/24/2024] Open
Abstract
BACKGROUND A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation. CASE A 30-year-old male presented with sudden onset syncope and the passage of 200-300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy's lesion. CONCLUSIONS Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient's postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes.
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Affiliation(s)
- Shikhar Tripathi
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplant, Sir Ganga Ram Hospital, New Delhi, India.
| | - Rakesh Narayanagowda
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplant, Sir Ganga Ram Hospital, New Delhi, India
| | - Sri Aurobindo Prasad Das
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplant, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunila Jain
- Department of Pathology (Histopathology Division), Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplant, Sir Ganga Ram Hospital, New Delhi, India
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Bathobakae L, Russo J, Adalja D, Mohtadi M, Wilkinson T, Mekheal N, Yuridullah R, Amer K, Cavanagh Y, Baddoura W. Dieulafoy's Lesion in the Esophagus Causing Gastrointestinal Bleeding: A Concise Review. J Community Hosp Intern Med Perspect 2024; 14:82-88. [PMID: 39839160 PMCID: PMC11745175 DOI: 10.55729/2000-9666.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 09/12/2024] [Accepted: 09/20/2024] [Indexed: 01/23/2025] Open
Abstract
Dieulafoy's lesion (DL) is an uncommon cause of life-threatening gastrointestinal (GI) bleeding. It can occur in any part of the GI tract, including the stomach, duodenum, colon, and esophagus. Dieulafoy's lesion in the esophagus (DLE) is an exceedingly rare entity, with only 23 case reports/series (27 patients) reported to date. We performed a systematic search of published case reports on DLE in PubMed, Google Scholar, and Embase, from inception through January 2024. The search terms for the review were "Dieulafoy's lesion," "esophagus," "oesophagus," "hematemesis," "melena," "hematochezia," and "gastrointestinal bleeding." Articles were eligible for inclusion in the study if they were published in English, described a case of DLE noted on endoscopy or histopathology, and were available as full text. Our literature search yielded 23 articles consisting of 27 patients. Of the 27 patients, eight (30%) were female and 19 (70%) were male. The patients' age ranged from 13 years to 87 years, with an average age of 54.1 years. Twenty-five patients (92.6%) presented with hematemesis and melena as chief complaints. DLE was found in the distal esophagus in 19/27 (70.4%) of the patients and the mid-esophagus in 6/27 (22.2%) of the patients. Two patients had no information about the lesion site. Endoscopic hemoclips were employed in 12 (44.4%) patients, endoscopic band ligation (EBL) in six and electrocautery was used in one patient. Early diagnosis and prompt treatment are crucial for managing DLE, as they can cause recurrent bleeding and potentially lead to complications or death.
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Affiliation(s)
- Lefika Bathobakae
- Internal Medicine, St. Joseph’s University Medical Center, Paterson,
USA
| | - Joseph Russo
- Internal Medicine, St. Joseph’s University Medical Center, Paterson,
USA
| | - Devina Adalja
- Internal Medicine, St. Joseph’s University Medical Center, Paterson,
USA
| | - Malina Mohtadi
- Internal Medicine, St. Joseph’s University Medical Center, Paterson,
USA
| | - Tyler Wilkinson
- Medical Education, St. George’s University School of Medicine, Grenada,
West Indies
| | - Nader Mekheal
- Internal Medicine, St. Joseph’s University Medical Center, Paterson,
USA
| | - Ruhin Yuridullah
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson,
USA
| | - Kamal Amer
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson,
USA
| | - Yana Cavanagh
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson,
USA
- Advanced & Surgical Endoscopy, St. Joseph’s University Medical Center, Paterson,
USA
| | - Walid Baddoura
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson,
USA
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Tan L, Gilbert JD, Byard RW. Fatal exulceratio simplex (dieulafoy lesion) - a case report and review. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00895-4. [PMID: 39298100 DOI: 10.1007/s12024-024-00895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 09/21/2024]
Abstract
A 64-year-old man involved in a low-speed vehicle crash was found at autopsy to have altered blood extending from his stomach to his rectum. Within the stomach a small arterial vessel opened onto the mucosa of the posterior wall of the antrum adjacent to the pylorus with no adjacent mucosal ulceration or malignancy. Histologic sections showed the typical appearances of a Dieulafoy lesion with a tortuous small arteriole within the submucosa extending to the gastric lumen with an overlying cap of recently formed clot. There were no injuries attributable to the vehicle collision. Death was due to a bleeding Dieulafoy lesion of the stomach with a background of cardiomegaly. Dieulafoy lesion of the stomach is a rare disorder accounting for only 1-2% of cases of acute gastrointestinal hemorrhage. Although its pathogenesis is poorly understood it is capable of producing life-threatening bleeding, as in the present case. The small size of the lesion may make it difficult to identify at the time of autopsy.
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Affiliation(s)
- Luzern Tan
- Adelaide Medical School, The University of Adelaide, Frome Road, Level 2, Room N237, Helen Mayo North, Adelaide, SA, 5005, Australia
| | - John D Gilbert
- Forensic Science South Australia, 21 Divett Place, Adelaide, South Australia, 5005, Australia
| | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Frome Road, Level 2, Room N237, Helen Mayo North, Adelaide, SA, 5005, Australia.
- Forensic Science South Australia, 21 Divett Place, Adelaide, South Australia, 5005, Australia.
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13
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Chaemsupaphan T, Geeratragool T, Angkathunyakul N, Phothisirisakulwong A, Maneerattanaporn M. Jejunal Dieulafoy's lesion resembling subepithelial mass resulting in profound gastrointestinal hemorrhage. Clin Endosc 2024; 57:552-554. [PMID: 38549243 PMCID: PMC11294852 DOI: 10.5946/ce.2023.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 07/31/2024] Open
Affiliation(s)
- Thanaboon Chaemsupaphan
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanawat Geeratragool
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Napat Angkathunyakul
- Department of Pathology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Monthira Maneerattanaporn
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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14
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Jhanji N, Lovingood C, Oelsner WK, Pitcher JE, Parsa L. Rare Colonic Dieulafoy Lesions: A Case Series. Cureus 2024; 16:e62446. [PMID: 39015856 PMCID: PMC11250557 DOI: 10.7759/cureus.62446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/18/2024] Open
Abstract
Dieulafoy lesions (DLs) are infrequent causes of gastrointestinal bleeding (GIB) but can cause hemorrhage with a high risk of re-bleeds. They are most noted in the stomach, but this case series of three colonic DLs highlights even more rare causes of lower GIB. Three patients presented with blood loss and were found to have colonic DLs. All of them had esophagogastroduodenoscopies (EGDs) that were unremarkable, and they subsequently underwent a colonoscopy, which then showed oozing DLs. First, a 63-year-old woman had a week of maroon-colored stools but no use of blood thinners, prior GIB, or peptic ulcers. Next, an 81-year-old man presented with dyspnea and had a two-week history of melena. Three years later, he presented with two oozing lesions on a colonoscopy, which likely indicated a repeat DL. This was followed by multiple admissions for GIB. The lesions in these two cases were treated with epinephrine and hemostatic clips. Lastly, a 49-year-old man presented with hematochezia leading to shock, requiring transfusions, vasopressors, and ICU care. Computed tomography angiography (CTA) showed intraluminal contrast extraversion in the ascending colon, leading to interventional radiology (IR)-guided coil for suspected DL. Diagnosis can be hard, but early identification through endoscopy can help decrease mortality rates. Therefore, it is crucial to keep this on the list of differential diagnoses in cases with no other identifiable sources to allow for timely management.
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Affiliation(s)
- Nancy Jhanji
- Internal Medicine, University of Tennessee College of Medicine, Chattanooga, USA
| | - Connor Lovingood
- Internal Medicine, University of Tennessee College of Medicine, Chattanooga, USA
| | - William K Oelsner
- Gastroenterology, University of Tennessee College of Medicine, Chattanooga, USA
| | - James E Pitcher
- Internal Medicine, University of Tennessee College of Medicine, Chattanooga, USA
| | - Laxmi Parsa
- Gastroenterology and Hepatology, University of Tennessee College of Medicine, Chattanooga, USA
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15
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Aabdi B, Kharrasse G, Zazour A, Koulali H, Elmqaddem O, Zahi I. Clinical, endoscopic and therapeutic features of bleeding Dieulafoy's lesions: case series and literature review. BMJ Open Gastroenterol 2024; 11:e001299. [PMID: 38789268 PMCID: PMC11129027 DOI: 10.1136/bmjgast-2023-001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE Dieulafoy's lesions (DLs) are a rare but potentially life-threatening source of gastrointestinal (GI) haemorrhage. They are responsible for roughly 1%-6.5% of all cases of acute non-variceal GI bleeding.Here, we describe retrospectively the clinical and endoscopic features, review the short-term and long-term outcomes of endoscopic management of bleeding DLs and we identify rate and risk factors, of recurrence and mortality in our endoscopic unit. DESIGN Data were collected from patients presenting with GI haemorrhagic secondary to DLs between January 2018 and August 2023. Patients' medical records as well as endoscopic databases were retrospectively reviewed. Demographic data, risk factors, bleeding site, outcomes of endoscopy techniques, recurrence and mortality rate were taken into account. RESULTS Among 1170 cases of GI bleeding, we identified only seven cases involving DLs. Median age was 74 years, with a male-to-female ratio of 2.5. 75% of patients had significant comorbidities, mainly cardiovascular diseases. Only anticoagulant and antiplatelet agents were significantly associated with DLs. All patients were presented with GI bleeding as their initial symptom. The initial endoscopy led to a diagnosis in 85% of the cases. Initial haemostasis was obtained in all patients treated endoscopically. Nevertheless, the study revealed early recurrence in two out of three patients treated solely with epinephrine injection or argon plasma coagulation. In contrast, one of three patients who received combined therapy, experienced late recurrence (average follow-up of 1 year). Pathological diagnosis was necessary in one case. One patient (14%) died of haemorrhagic shock. Average length of hospital stay was 3 days. CONCLUSION Although rare, DLs may be responsible for active, recurrent and unexplained GI bleeding. Thanks to the emergence of endoscopic therapies, the recurrence rate has decreased and the prognosis has highly improved. Therefore, the endoscopic approach remains the first choice to manage bleeding DLs.
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Affiliation(s)
- Basma Aabdi
- Gastroenterology, Mohammed VI University Hospital Oujda, Morocco, Oujda, Morocco
| | - Ghizlane Kharrasse
- Gastroenterology, Mohammed VI University Hospital Oujda, Morocco, Oujda, Morocco
| | - Abdelkrim Zazour
- Digestive Disease Research Laboratory (LARMAD), Mohammed I University, Faculty of Medicine and Pharmacy, Oujda, Morocco, Oujda, Morocco
| | - Hajar Koulali
- Digestive Disease Research Laboratory (LARMAD), Mohammed I University, Faculty of Medicine and Pharmacy, Oujda, Morocco, Oujda, Morocco
| | - Ouiam Elmqaddem
- Digestive Disease Research Laboratory (LARMAD), Mohammed I University, Faculty of Medicine and Pharmacy, Oujda, Morocco, Oujda, Morocco
| | - Ismaili Zahi
- Gastroenterology, Mohammed VI University Hospital Oujda, Morocco, Oujda, Morocco
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16
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Wasserman RD, Abel W, Monkemuller K, Yeaton P, Kesar V, Kesar V. Non-variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:599-608. [PMID: 39150279 PMCID: PMC11363156 DOI: 10.5152/tjg.2024.23507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/17/2024] [Indexed: 08/17/2024]
Abstract
Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality. Clinical symptoms that patients may present with include: hematemesis, coffee-ground emesis, melena, and hematochezia. Clinical signs can range from tachycardia to shock. The anatomical landmark that differentiates upper gastrointestinal (GI) bleeds from lower bleeds is the ligament of Treitz. The first steps of treating a patient who presents with signs of UGIB are resuscitation with appropriate fluids and blood products as necessary. The consideration of endoscopy and the urgency at which it should be performed is also vital during initial resuscitation. Endoscopic therapy should ideally be performed within 24 hours of presentation after initial stabilization with crystalloids and blood products. Intravenous proton pump inhibitors are the mainstay in the initial management of upper GI bleeding from a non-variceal etiology, and they should be administered in the acute setting to decrease the probability of high-risk stigmata seen during endoscopy. Pro-kinetic agents can be given 30 minutes to an hour before endoscopy and may aid in the diagnosis of UGIB. There are 3 broad categories of endoscopic management for UGIB: injection, thermal, and mechanical. Each endoscopic method can be used alone or in combination with others; however, the injection technique with epinephrine should always be used in conjunction with another method to increase the success of achieving hemostasis. In this review article, we will review the steps of triage and initial resuscitation in UGIB, causes of UGIB and their respective management, several endoscopic techniques and their effectiveness, and prognosis with a primary focus limited to non-variceal bleeding.
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Affiliation(s)
- Reid D. Wasserman
- Department of Internal Medicine, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - William Abel
- Department of Internal Medicine, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Klaus Monkemuller
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Paul Yeaton
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Vivek Kesar
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Varun Kesar
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
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17
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Postoll-Downs MA, Ozguc F, Vasudevan J, Stawinski PM, Wright R. Breaking Patterns: A Case of Dieulafoy Lesion in a Young Patient Without Comorbid Conditions. Cureus 2024; 16:e60513. [PMID: 38883023 PMCID: PMC11180519 DOI: 10.7759/cureus.60513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
A Dieulafoy lesion is an abnormal artery located in the gastric submucosa that represents a rare cause of upper gastrointestinal bleeding. These lesions typically present as massive hemorrhages in older patients, with multiple medical comorbidities. The lesions are diagnosed with endoscopy and treated with hemostasis by clip placement or coagulation. This case report is that of a rare presentation of this rare condition in a younger 18-year-old patient with no medical comorbidities. He presented with hematemesis, melena, and syncope in the setting of ibuprofen self-treatment for a recent upper viral illness. This medication use is a proposed inciting factor for the bleeding lesion, though he had a history of a splenic artery embolization following a remote motor vehicle accident, which could represent a mechanism for a rare acquired lesion. A gastroenterologist was consulted and assisted in the diagnosis and management of this patient. His lesion was identified and treated within 24 hours of his presentation.
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Affiliation(s)
- Melissa A Postoll-Downs
- Internal Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
| | - Fatma Ozguc
- Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Jaya Vasudevan
- Gastroenterology, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Peter M Stawinski
- Gastroenterology, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Randy Wright
- Gastroenterology, The University of Texas Health Science Center at San Antonio, San Antonio, USA
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18
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Han P, Li D, Guo Q, Lei Y, Liu J, Tian D, Yan W. Over-the-scope clip as a rescue treatment for massive bleeding due to Dieulafoy lesion at the colorectal anastomosis: A case report. Medicine (Baltimore) 2024; 103:e37871. [PMID: 38640308 PMCID: PMC11030013 DOI: 10.1097/md.0000000000037871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE The bleeding of Dieulafoy lesion predominantly involves the proximal stomach and leads to severe gastrointestinal bleeding. However, these lesions have also been reported in the whole gastrointestinal tract. Bleeding of Dieulafoy lesions at the anastomosis was seldomly reported and was very easy to be ignored clinically. PATIENT CONCERNS We describe a 72-year-old woman with a past history of surgery for rectal carcinoma hospitalized with chief complaint of massive rectal bleeding. No gross bleeding lesion was found during the first emergency colonoscopy. Despite multiple blood transfusions, her hemoglobin rapidly dropped to 5.8 g/dL. DIAGNOSIS She was diagnosed with Dieulafoy lesion at the colorectal anastomosis during the second emergency colonoscopy. INTERVENTIONS Primary hemostasis was achieved by endoscopic hemostatic clipping. However, she experienced another large volume hematochezia 3 days later, and then received another endoscopic hemostatic clipping. She was improved and discharged. However, this patient underwent hematochezia again 1 month later. Bleeding was arrested successfully after the over-the-scope clip (OTSC) was placed during the fourth emergency colonoscopy. OUTCOMES This patient underwent 4 endoscopic examinations and treatments during 2 hospitalizations. The lesion was overlooked during the first emergency colonoscopy. The second and third endoscopes revealed Dieulafoy lesion at the colorectal anastomosis and performed endoscopic hemostatic clippings, but delayed rebleeding occurred. The bleeding was stopped after the fourth emergency colonoscopy using OTSC. There was no further rebleeding during hospitalization and after 2-year of follow-up. LESSONS As far as we know, there is no reported case of lower gastrointestinal bleeding caused by Dieulafoy lesion at the colorectal anastomosis, OTSC is a safe and effective rescue treatment for Dieulafoy lesions.
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Affiliation(s)
- Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Demin Li
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Qiaozhen Guo
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yu Lei
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jingmei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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19
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Zazour A, Belkhayat C, Bennani A, Bouziane M, Kharrasse G, Ismaili Z. Two cases of Dieulafoy's lesion in unusual sites: A rare case reports of gastrointestinal bleeding. Int J Surg Case Rep 2024; 117:109562. [PMID: 38518467 PMCID: PMC10972791 DOI: 10.1016/j.ijscr.2024.109562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Dieulafoy's lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It's usually found in the stomach. However, DL's occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management challenges. CASE PRESENTATION In this report, we present two cases of DL occurring in uncommon sites, each managed with distinct approaches. Case 1 is a 50-year-old man admitted to the emergency department due to massive GI bleeding and hemodynamic instability. The diagnosis of DL was established through computed tomography angiography and confirmed by histopathological examination after emergency surgery. Case 2 involves a 68-year-old woman presented with melena due to a colonic DL. This case was successfully managed through an endoscopic hemostasis approach. DISCUSSION Dieulafoy's lesions (DL) were first identified as a large submucosal artery lacking typical gastric ulcer characteristics in three of Paul Georges Dieulafoy's patients. This lesion is responsible for approximately 1-2 % of all cases of gastrointestinal bleeding. Endoscopy is the preferred method for diagnosing and managing DL lesions, especially in cases of active bleeding that is accessible. However, if endoscopic treatment or angiographic embolization fails, a surgical approach may be needed. CONCLUSION DL presents a diagnostic challenge due to its rarity and is not usually included in the differential diagnosis of gastrointestinal bleeding, particularly when occurring in unusual sites. Endoscopy is the preferred method to identify DL and a possible therapeutic approach in active bleeding. However, if endoscopy hemostasis fails, angiographic embolization or surgical intervention may be required.
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Affiliation(s)
- Abdelkrim Zazour
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco.
| | - Chifaa Belkhayat
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Amal Bennani
- Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Mohamed Bouziane
- General Surgery Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Ghizlane Kharrasse
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Zahi Ismaili
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
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20
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Alvi AT, Tchouambou E, Shankar M. Percutaneous Endoscopic Gastrostomy: A Possible Trigger for Dieulafoy's Lesion. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:45-48. [PMID: 38560388 PMCID: PMC10939086 DOI: 10.36518/2689-0216.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Upper gastrointestinal (GI) bleeding is a medical condition commonly seen in clinical practice due to variable etiologies and a multitude of presentations. The patients can present with hematemesis, melena, or hematochezia in case of severe bleeding. The initial evaluation should involve assessing the hemodynamic status with adequate resuscitation followed by diagnostic tests to identify the source and potentially treat it. Dieulafoy's lesion, sometimes referred to as Dieulafoy's disease, is a rare cause of upper GI bleeding with no clear risk factors, which makes it a diagnostic conundrum. Here we describe an unusual case of Dieulafoy's lesion developing following percutaneous endoscopic gastrostomy (PEG) placement. Case Presentation We describe a case of a 70-year-old female patient with a past medical history of hyperlipidemia, well-controlled hypertension, and an ischemic cerebrovascular accident, which caused neurologic dysphagia and placement of a PEG tube 3 weeks prior. She presented to the emergency department due to melena, with hypotension of 90/50 mmHg, tachycardia of 126 beats/minute, and hemoglobin of 5.6 g/dl. An endoscopy revealed a Dieulafoy's lesion on the lesser curvature of the stomach just across the PEG tube, which was managed with epinephrine and hemoclips. Conclusion This is a rare case of Dieulafoy's lesion on the lesser curvature of the stomach, potentially developing due to PEG placement.
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21
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Son JH. Life-threatening Gastrointestinal Bleeding from a Dieulafoy's Lesion in the Duodenum: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:119-122. [PMID: 38522855 DOI: 10.4166/kjg.2024.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 03/26/2024]
Abstract
Dieulafoy's lesion is a rare cause of gastrointestinal bleeding, accounting for approximately 1-2% of all cases of gastrointestinal bleeding. Dieulafoy's lesion usually occurs in the lesser curvature of the stomach within six centimeters of the gastroesophageal junction. On the other hand, extragastric Dieulafoy's lesions are uncommon. Diagnosing an extragastric Dieulafoy's lesion by endoscopy can be challenging because of its small size and obscure location. The key elements for an accurate diagnosis include heightened awareness and a careful early endoscopic evaluation following a bleeding episode. Various endoscopic hemostatic techniques can be used for treatment. This paper presents a case of successful hemostasis using argon plasma coagulation for a life-threatening duodenal Dieulafoy's lesion.
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Affiliation(s)
- Jun Hyuk Son
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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22
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Ribeiro M, Silva RA, Oliveira DR, Fernandes D, Neiva F. A Pediatric Gastric Dieulafoy Lesion: A Case Report and Literature Review. Cureus 2024; 16:e55376. [PMID: 38562364 PMCID: PMC10983821 DOI: 10.7759/cureus.55376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
This report presents a case of a 16-year-old male with severe upper gastrointestinal bleeding caused by a Dieulafoy lesion (DL). A DL is a rare but life-threatening condition characterized by sudden and massive bleeding from a small arterial vessel in the gastrointestinal (GI) tract. Diagnosis is often made through esophagogastroduodenoscopy (EGD), which reveals an enlarged submucosal blood vessel. The patient was successfully treated with adrenaline injection and hemoclipping during EGD. This case highlights the importance of considering a DL as a potential cause of severe upper GI bleeding in pediatric patients and emphasizes the significance of early recognition and intervention to achieve favorable outcomes. Additional investigation is required to enhance our comprehension of the occurrence, etiology, and most effective approaches to managing DLs in pediatric patients.
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Affiliation(s)
| | | | | | - Dália Fernandes
- Gastroenterology and Hepatology, Hospital de Braga, Braga, PRT
| | - Filipa Neiva
- Pediatrics, Unidade de Gastrenterologia Pediátrica, Serviço de Pediatria, Hospital de Braga, Braga, PRT
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23
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Atri S, Hammami M, Ouadi Y, Sebai A, Chaker Y, Kacem M. Dieulafoy's lesion: Is there still a place for surgery? About 2 cases. Int J Surg Case Rep 2024; 114:109166. [PMID: 38113567 PMCID: PMC10772228 DOI: 10.1016/j.ijscr.2023.109166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Dieulafoy's lesion, a rare but life-threatening condition accounting for a small percentage of acute gastrointestinal bleeding cases, has historically posed diagnostic and therapeutic challenges. CASE PRESENTATION In this article, we present two cases that required surgical intervention due to unsuccessful attempts with endoscopy. Case 1 involved a 40-year-old patient with a history of treated duodenal ulcers, while Case 2 featured a 74-year-old woman with no notable medical history. Both patients exhibited severe bleeding, necessitating urgent surgical procedures. The surgical approach involved wide gastrotomy, careful inspection, and successful suturing of the bleeding vessel. DISCUSSION Dieulafoy lesions, discovered by French surgeon Georges Dieulafoy in 1885, constitute 1-2 % of acute gastrointestinal bleeding cases. These anomalies involve enlarged submucosal arteries, predominantly in the stomach, but occurrences in other sites are documented. Endoscopic methods, surpassing surgical intervention, are preferred for treatment, boasting success rates over 90 %. Surgical measures become a last resort for uncontrolled bleeding, with laparoscopic surgery emerging as a minimally invasive alternative, facilitated by various intra-operative localization techniques. Laparoscopic wedge resection, in particular, exhibits lower re-bleeding rates than traditional oversewing methods, although feasibility depends on lesion location. CONCLUSION While endoscopic methods are preferred, surgery remains a vital option when bleeding persists or endoscopic intervention fails. This report highlights the significance of surgical management in selected cases of Dieulafoy's lesion.
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Affiliation(s)
| | | | | | - Amine Sebai
- Department, Hopital la Rabta, Tunis, Tunisia
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24
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Kocic M, Rasic P, Marusic V, Prokic D, Savic D, Milickovic M, Kitic I, Mijovic T, Sarajlija A. Age-specific causes of upper gastrointestinal bleeding in children. World J Gastroenterol 2023; 29:6095-6110. [PMID: 38186684 PMCID: PMC10768410 DOI: 10.3748/wjg.v29.i47.6095] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
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Affiliation(s)
- Marija Kocic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Vuk Marusic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Dragan Prokic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivana Kitic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Adrijan Sarajlija
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Pediatric Day Care Hospital Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Eastern Sarajevo, Foča 73300, Bosnia and Herzegovina
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25
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Apthorp E, Ndungu MM, Rumwanpura K, Rahmani MJ. Dieulafoy's lesion: a rare but potentially life-threatening cause of gastrointestinal bleeding. Br J Hosp Med (Lond) 2023; 84:1. [PMID: 38019202 DOI: 10.12968/hmed.2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
| | - Marta Mungai Ndungu
- Department of Health and Ageing, Conquest Hospital, East Sussex Hospitals Trust, St Leonards on Sea, East Sussex, UK
| | - Kelum Rumwanpura
- Department of Health and Ageing, Conquest Hospital, East Sussex Hospitals Trust, St Leonards on Sea, East Sussex, UK
| | - Muhammad Jh Rahmani
- Department of Health and Ageing, Conquest Hospital, East Sussex Hospitals Trust, St Leonards on Sea, East Sussex, UK
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26
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Yahia ZA, Almutawa SM, Bantan BN, Alghamdi MS. Dieulafoy's Lesion in a Duodenal Diverticulum: A Case Report and Literature Review. Cureus 2023; 15:e46584. [PMID: 37937004 PMCID: PMC10627415 DOI: 10.7759/cureus.46584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
This report presents a case of Dieulafoy's lesion (DL), a rare and serious gastrointestinal condition, which occurred unusually in a duodenal diverticulum and highlights the diagnostic and management complexities associated with it. A literature review of six similar cases revealed commonalities in presentation, diagnosis, and management, emphasizing the complexities in identifying and handling this rare manifestation of DL. The findings emphasize the need for clinical vigilance and further research into optimizing strategies for diagnosing and managing this rare condition.
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Affiliation(s)
- Zolfekar A Yahia
- Department of Gastroenterology, Alnoor Specialist Hospital, Makkah, SAU
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27
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Hu Q, Guo Y, Fan H, Wu X, Chen H, Zeng C. Pathological features of vascular wall in Dieulafoy's disease. Pathol Res Pract 2023; 249:154782. [PMID: 37639956 DOI: 10.1016/j.prp.2023.154782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
AIMS Although there are many clinical reports on Dieulafoy's disease, there are few studies on the pathological structure of vascular wall in Dieulafoy's disease. METHODS In this study, the main structural changes of the intima and media of the vascular wall were observed by special staining and immunohistochemical methods in the subjects of Dieulafoy's disease of stomach and intestine. RESULTS There were many vessels of different sizes in the submucosa, with uneven wall thickness of the vessels. Compared with the normal control group, the content of blue collagen fibers between the vascular smooth muscle cells in the lesion group was increased, the elastic fibers were thickened, and the internal elastic plate was arranged stiff or even interrupted. CONCLUSIONS The increase of collagen and elastic fibers between the smooth muscle cells of the medium membrane and the destruction of the structure of the inner elastic plate may be the structural basis of vascular lesions leading to Dieulafoy's disease.
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Affiliation(s)
- Qiaoling Hu
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China
| | - Yimin Guo
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China
| | - Huan Fan
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China
| | - Xiaobin Wu
- Department of Gastrointestinal Surgery, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong 518033, PR China.
| | - Honglei Chen
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China.
| | - Chao Zeng
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, PR China.
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28
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Sacoto DH, Turbay-Caballero V, Reyes-Castro T, Quintanilla BS, Lolo D. Progression of a Rare Disease, Takayasu Arteritis, With Hematologic and Gastrointestinal Manifestations: A Four-Year Follow-Up Study. Cureus 2023; 15:e45950. [PMID: 37885508 PMCID: PMC10599199 DOI: 10.7759/cureus.45950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Takayasu arteritis (TA) is a heterogeneous disease whose presentation and progression have not yet been well described. An elderly female was diagnosed with TA after presenting with bilateral arm claudication, elevated ESR, and bilateral subclavian arterial stenosis. In the first two years after diagnosis, she was diagnosed with monoclonal gammopathy of undetermined significance and alpha thalassemia minor. For the next two years, she presented with a non-ST elevation myocardial infarction, three oozing Dieulafoy lesions, and eosinophilic esophagitis. As we observed, TA can have an unusual and unpredictable progression. Therefore, a multidisciplinary approach and clinical surveillance are paramount.
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Affiliation(s)
| | | | - Tiago Reyes-Castro
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Bryan S Quintanilla
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Delatre Lolo
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
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29
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Cho JJ, Forbes CM, Fiore BD, McCarron JD, Padilla L. Sustained Hemostasis With the Padlock™ Over-the-scope Clip for Gastric Fundus Dieulafoy's Lesion in the Setting of Anticoagulation Following Hemorrhagic Shock From Two Dieulafoy's Lesions. Mil Med 2023; 188:e3265-e3268. [PMID: 36355858 DOI: 10.1093/milmed/usac335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 08/31/2023] Open
Abstract
Dieulafoy's lesions (DLs) are a rare and difficult-to-identify cause of acute gastrointestinal bleeding that can lead to hemorrhagic shock. We present a case of a 23-year-old previously healthy male presenting with melenic stools and hemorrhagic shock. Computed tomography of abdomen and pelvis with oral and intravenous contrast showed a possible source of hemorrhage as a hyperdense intraluminal material within the stomach. Initial urgent esophagogastroduodenoscopy showed a large, nonbleeding distal esophageal DL, which was treated successfully with 10 mL of 1:10,000 epinephrine and bipolar cauterization with 10 Fr Gold Probe™. Hemorrhage recurred 2 d later, prompting another esophagogastroduodenoscopy, which found another DL within the gastric fundus. Treatment with epinephrine, Gold Probe™, and through-the-scope Hemoclips was unsuccessful because of difficult visualization and positioning. A subsequent attempt was made using the over-the-scope clip (OTSC) Padlock™ Clip Defect Closure System with successful hemostasis and stabilization of the patient. His hospital course was complicated by left lower lobe segmental pulmonary embolism without right heart strain for which he was discharged on 3 months of anticoagulation with apixaban. On follow-up, there was no recurrence of gastrointestinal bleeding (GIB) despite 3 months of anticoagulation. He did not complete the Basic Underwater Demolition/SEAL (BUD/S) Training. This case report demonstrates the evaluation and management of a patient with hemorrhagic shock from two DLs and sustained hemostasis with the Padlock™ OTSC in the setting of apixaban anticoagulation.
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Affiliation(s)
- Jonathan J Cho
- Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Chelsea M Forbes
- Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Benjamin D Fiore
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Joshua D McCarron
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Leybelis Padilla
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
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30
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Nakamura M, Yamamura T, Maeda K, Sawada T, Ishikawa E, Furukawa K, Iida T, Mizutani Y, Yamao K, Ishikawa T, Honda T, Ishigami M, Kawashima H. Clinical characteristics of Dieulafoy's lesion in the small bowel diagnosed and treated by double-balloon endoscopy. BMC Gastroenterol 2023; 23:290. [PMID: 37620810 PMCID: PMC10464443 DOI: 10.1186/s12876-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Obscure gastrointestinal bleeding refers to bleeding for which the source cannot be ascertained even through balloon-assisted endoscopy. In certain instances, Dieulafoy's lesion in the small bowel is presumed to be the underlying cause. AIM This retrospective study aimed to elucidate the clinical characteristics of Dieulafoy's lesion in the small bowel as diagnosed via double-balloon endoscopy while also exploring the feasibility of predicting bleeding from Dieulafoy's lesion prior to endoscopy in cases of obscure gastrointestinal bleeding. METHODS A comprehensive analysis of our database was conducted, identifying 38 patients who received a diagnosis of Dieulafoy's lesion and subsequently underwent treatment via double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy's lesion were carefully examined. RESULTS The median age of the 38 patients was 72 years, and 50% of the patients were male. A total of 26 (68%) patients exhibited a high comorbidity index. The upper jejunum and lower ileum were the most frequently reported locations for the occurrence of Dieulafoy's lesion in the small bowel. The detected Dieulafoy's lesions exhibited active bleeding (n = 33) and an exposed vessel with plaque on the surface (n = 5). Rebleeding after endoscopic treatment occurred in 8 patients (21%, median period: 7 days, range: 1-366 days). We conducted an analysis to determine the definitive nature of the initial double-balloon endoscopy diagnosis. Multivariate analysis revealed that hematochezia of ≥ 2 episodes constituted the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. Additionally, we explored factors associated with rebleeding following endoscopic treatment. Although the number of hemoclips utilized displayed a likely association, multivariate analysis did not identify any independent factor associated with rebleeding. CONCLUSION If a patient encounters multiple instances of hematochezia, promptly scheduling balloon-assisted endoscopy, equipped with optional instruments without delay is advised, after standard endoscopic evaluation with esophagogastroduodenoscopy and colonoscopy is unrevealing.
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Affiliation(s)
- Masanao Nakamura
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kentaro Yamao
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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31
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Martínez-Ortiz CA, Alvarez-Sores ED, Lara-Orozco U, Murcio-Pérez E. Dieulafoy's lesion of the rectum: A case report. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:301-304. [PMID: 37208209 DOI: 10.1016/j.rgmxen.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/23/2023] [Indexed: 05/21/2023]
Affiliation(s)
- C A Martínez-Ortiz
- Departamento de Gastrocirugía, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - E D Alvarez-Sores
- Departamento de Gastrocirugía, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
| | - U Lara-Orozco
- Departamento de Gastrocirugía, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - E Murcio-Pérez
- Departamento de Endoscopia Gastrointestinal, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
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32
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Xie X, Qin J, Ma X, Liu S. Gastrointestinal Bleeding From a Transverse Colon Dieulafoy Lesion. Cureus 2023; 15:e42703. [PMID: 37654923 PMCID: PMC10467642 DOI: 10.7759/cureus.42703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Dieulafoy lesions are an extremely rare disease that can cause gastrointestinal bleeding and colon bleeding. Lower gastrointestinal bleeding caused by a transverse colonic Dieulafoy lesion is extremely rare. This study describes the case of a 68-year-old woman who took oral rivaroxaban for atrial fibrillation and presented with massive lower gastrointestinal bleeding associated with a rare transverse colonic Dieulafoy lesion. Hemostasis was successfully achieved by thermal coagulation and the application of endoscopic hemoclips. Lastly, we reviewed previous literature on the diagnosis and treatment of colonic Dieulafoy disease.
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Affiliation(s)
- Xinyu Xie
- Department of Gastroenterology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, CHN
| | - Jian Qin
- Department of Gastroenterology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, CHN
| | - Xiaojua Ma
- Department of Gastroenterology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, CHN
| | - Shanshan Liu
- Department of Gastroenterology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, CHN
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33
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Qasim A, Schmidt P, Bhatt T, Itare V, Ihimoyan A, Khaja M, Kandhi S. Dieulafoy's Lesion of the Duodenum: A Rare and Fatal Cause of Gastrointestinal Bleed. Cureus 2023; 15:e40050. [PMID: 37425531 PMCID: PMC10324985 DOI: 10.7759/cureus.40050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Dieulafoy's lesion (DL) is an unusual cause of recurrent gastrointestinal bleeding that can be fatal. It can occur in various parts of the gastrointestinal (GI) tract, most commonly located in the stomach, especially at the level of lesser curvature; however, it can occur in other parts, including the colon, esophagus, and duodenum. A duodenal Dieulafoy lesion is characterized by the presence of a larger-caliber artery that protrudes through the GI mucosa and can lead to massive hemorrhage. The exact cause of DL is yet to be determined. Clinical presentation includes painless upper GI bleeding, including melena, hematochezia, and hematemesis, or rarely iron deficiency anemia (IDA); however, most of the patients are asymptomatic. Some patients also have non-gastrointestinal comorbidities such as hypertension, diabetes, and chronic kidney disease (CKD). The diagnosis is established by esophagogastroduodenoscopy (EGD), which includes the presence of micro pulsatile streaming from a mucosal defect, the appearance of a fresh, densely adherent clot with a narrow point of attachment to a minute mucosal defect, and the visualization of a protruding vessel with or without bleeding. Initial EGD can be non-diagnostic due to the relatively small size of the lesion. Other diagnostic modalities include endoscopic ultrasound and mesenteric angiography. The treatment of duodenal DL includes thermal electrocoagulation, local epinephrine injection, sclerotherapy, banding, and hemoclipping. We present here a case of a 71-year-old female who had a history of severe IDA requiring multiple blood transfusions and intravenous iron in the past and was found to have duodenal DL.
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Affiliation(s)
- Abeer Qasim
- Internal Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Vikram Itare
- Internal Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Sameer Kandhi
- Internal Medicine, BronxCare Health System, Bronx, USA
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34
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Garg H, Padia G, Raj A, Khanna S, Vohra S. Over-the-scope clip for Dieulafoy's lesion: A new 'normal' technique. Indian J Gastroenterol 2023; 42:438-439. [PMID: 37247178 DOI: 10.1007/s12664-023-01364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Hitendra Garg
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, 110 076, India.
| | - Gaurav Padia
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, 110 076, India
| | - Anupam Raj
- Department of Anesthesia, Indraprastha Apollo Hospital, New Delhi, 110 076, India
| | - Sudeep Khanna
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, 110 076, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, 110 076, India
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35
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Uehara N, Inoue K, Kuroki Y, Miyao N, Iwahashi K, Suzuki R, Endo T, Asonuma K, Yoshida E, Koshibu N, Tabuchi A, Tohata M, Hanamura S, Gomi K, Yamamoto Y, Nagahama M. Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding. DEN OPEN 2023; 3:e184. [PMID: 36426137 PMCID: PMC9680167 DOI: 10.1002/deo2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment. METHODS This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis. RESULTS The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing.In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80-14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09-0.88, p = 0.035). CONCLUSIONS In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis-related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.
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Affiliation(s)
- Natsumi Uehara
- Department of GastroenterologyMedical Topia Soka HospitalSaitamaJapan
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Kazuaki Inoue
- Department of GastroenterologyInternational University of Health and Welfare Narita HospitalChibaJapan
| | - Yuichiro Kuroki
- Department of GastroenterologySt. Marianna University School of MedicineYokohama City Seibu HospitalKanagawaJapan
| | - Naoki Miyao
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | | | - Reika Suzuki
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Toshiyuki Endo
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Kunio Asonuma
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Erika Yoshida
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Naoko Koshibu
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Akihiro Tabuchi
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Misako Tohata
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Shotaro Hanamura
- Department of GastroenterologyKikuna Memorial HospitalKanagawaJapan
| | - Kuniyo Gomi
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Yorimasa Yamamoto
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
| | - Masatsugu Nagahama
- Department of GastroenterologyShowa University Fujigaoka HospitalKanagawaJapan
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Yano YI, Iguchi T, Sato S, Iseda N, Sasaki S, Abe Y, Nakayama T, Honboh T, Kato S, Sadanaga N, Matsuura H. Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report. Surg Case Rep 2023; 9:46. [PMID: 36961559 PMCID: PMC10039168 DOI: 10.1186/s40792-023-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Patients on long-term dialysis are prone to hemorrhagic complications, particularly uremic bleeding, but gallbladder hemorrhage is rare, even in patients on dialysis. There have been occasional reports of a Dieulafoy lesion being a cause of gastrointestinal hemorrhage, but its occurrence within the gallbladder is quite rare. This report describes a case of gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis that was diagnosed early and successfully treated by laparoscopic cholecystectomy. CASE PRESENTATION The patient was a 68-year-old woman on long-term hemodialysis with end-stage renal failure who presented with epigastralgia and back pain. There was no history of trauma or oral administration of antiplatelet or anticoagulant agents. There were no signs of an inflammatory reaction or hyperbilirubinemia. Contrast-enhanced computed tomography revealed a slightly hyperdense area in the distended gallbladder and extravasation within the gallbladder lumen but no gallstones. A severe atherosclerotic lesion was also found. She was diagnosed to have gallbladder hemorrhage and emergency laparoscopic cholecystectomy was performed. Although the postoperative course was complicated by drug fever, she was discharged on postoperative day 10 in a satisfactory condition. Histology revealed hemorrhagic ulceration with an exposed blood vessel accompanied by abnormal arteries in the submucosa. Arteriosclerosis with eccentric intimal hyperplasia in a small-sized artery was also seen. The diagnosis was gallbladder hemorrhage from a Dieulafoy lesion. CONCLUSIONS A Dieulafoy lesion should be kept in mind as a cause of gallbladder hemorrhage in a patient with severe arteriosclerosis and a bleeding diathesis, particularly if on dialysis, and treated as early as possible.
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Affiliation(s)
- Yuu-Ichi Yano
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Tomohiro Iguchi
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan.
| | - Shota Sato
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Norifumi Iseda
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Shun Sasaki
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Yasuhiro Abe
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Tomohiro Nakayama
- Department of Radiology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Takuya Honboh
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin Chuo-Ku, Fukuoka, Japan
| | - Noriaki Sadanaga
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Hiroshi Matsuura
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
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Kusnik A, Mostafa MR, Sharma RP, Chodos A. Dieulafoy Lesion: Scope it Until You Find it. Cureus 2023; 15:e36097. [PMID: 37065413 PMCID: PMC10097443 DOI: 10.7759/cureus.36097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
A Dieulafoy lesion is an important consideration every gastroenterologist and internal medicine physician has to make in cases of recurrent, unidentifiable, and hemodynamically compromising gastrointestinal (GI) bleeding. A Dieulafoy lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can result in severe, intermittent arterial bleeding from tiny, difficult-to-visualize vessel stumps. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. As the patients presenting with Dieulafoy lesions often have concomitant cardiac and renal disease, familiarity with this condition is relevant as these patients are at risk of transfusion-related injuries. This case is unique as the Dieulafoy lesion was not visualizable in a standard location despite multiple esophagogastroduodenoscopy (EGD) and CT angiography, illustrating the difficulty of accurately managing and diagnosing this condition.
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Jo SY, Noh JH, Cha B, Ahn JY, Oh SP, Seo JY, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding. J Gastroenterol Hepatol 2023. [PMID: 36740948 DOI: 10.1111/jgh.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico-epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes. METHODS Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated. RESULTS Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56-75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow-up period of 52 months (IQR, 34-70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518). CONCLUSIONS Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.
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Affiliation(s)
- Sang Yong Jo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boram Cha
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Pyo Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chaudhary SM, Singh A, Chavan M, Das A, Bathvar PK. Uncommon, overlooked and underreported causes of upper gastrointestinal bleeding. Intractable Rare Dis Res 2023; 12:13-21. [PMID: 36873674 PMCID: PMC9976090 DOI: 10.5582/irdr.2022.01128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Upper gastrointestinal bleeding (UGB) is a potentially fatal consequence of digestive disorders. There is a wide range of rare causes for UGB that can lead to misdiagnosis and occasionally catastrophic outcomes. The lifestyles of those who are afflicted are mostly responsible for the underlying conditions that result in the hemorrhagic cases. The development of a novel approach targeted at raising public awareness of the issue and educating the public about it could significantly contribute to the elimination of gastrointestinal bleeding with no associated risks and to a nearly zero mortality rate. There are reports of UGB related to Sarcina ventriculi, gastric amyloidosis, jejunal lipoma, gastric schwannoma, hemobilia, esophageal varices, esophageal necrosis, aortoenteric fistula, homosuccus pancreaticus, and gastric trichbezoar in the literature. The common feature of these rare causes of UGB is that the diagnosis is difficult to establish before surgery. Fortunately, UGB with a clear lesion in the stomach itself is a clear sign for surgical intervention, and the diagnosis can only be verified by pathological examination with the help of immunohistochemical detection of a particular antigen for a specific condition. The clinical traits, diagnostic techniques, and the therapeutic, or surgical options of unusual causes of UGB reported in the literature are compiled in this review.
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Affiliation(s)
| | - Ajay Singh
- Department of General Surgery, Sri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
- Address correspondence to:Ajay Singh, Department of General Surgery, Sri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India. E-mail:
| | - Manisha Chavan
- Department of General Surgery, Kakatiya Medical College, RangamPeta, Warangal, Telangana, India
| | - Arghadip Das
- Department of General Surgery, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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He ZW, Xu H, Shi H, Wang YM, Zhong H, Liu XC. Case report: Endoscopic Hemoclip treatment for massive hematemesis caused by a Dieulafoy's lesion on duodenal papilla caused acute pancreatitis. Front Med (Lausanne) 2023; 10:1108443. [PMID: 36936207 PMCID: PMC10017547 DOI: 10.3389/fmed.2023.1108443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background Dieulafoy's lesion is an uncommon cause of hemorrhage of the digestive tract. It often presents with urgent and massive bleeding usually leading to shock, even death. Dieulafoy's lesions have been reported throughout the digestive tract but which occurred on duodenal papilla were particularly rare and presented challenges in the choice of hemostasis. Case presentation A 66-year-old man with melena for 2 days was admitted. Gastrointestinal endoscopy revealed blood clots covering the duodenal papilla with oozing blood. During the procedure of trying to place a plastic stent into the duodenal papilla first, the hemorrhage began to present pulsating bleeding. The patient went into shock. With consent, two titanium clips were inserted to clamp the bleeding site to stop the bleeding. The patient complained of epigastric pain 14 h after the endoscopy. An abdominal CT scan showed signs of acute pancreatitis. Endoscopy was performed to remove the titanium clips and showed a vessel stump on the duodenal papilla. The patient was discharged from the hospital on the 14th day and followed for 6 months with no recurrence. Conclusion This case was diagnosed with a Dieulafoy's lesion on the duodenal papilla, which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips but caused acute pancreatitis. Reviewing the treatment, electrocoagulation might be a better choice, and life support treatment, including central vena catheterization and an adequate supply of blood products, should be prepared in advance to provide extra time for the stent placement or vascular intervention treatment.
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Affiliation(s)
- Zhi-wei He
- Ziyang First People’s Hosiptal, Ziyang, China
| | - Hui Xu
- Ziyang First People’s Hosiptal, Ziyang, China
| | - Hua Shi
- Ziyang First People’s Hosiptal, Ziyang, China
| | | | - Han Zhong
- Ziyang First People’s Hosiptal, Ziyang, China
| | - Xiao-cong Liu
- Chengdu Second People’s Hospital, Chengdu, China
- *Correspondence: Xiao-cong Liu,
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Han P, Lei Y, Hou W, Chen N, Liu J, Tian D, Guo Q, Yan W. Severe lower gastrointestinal bleeding caused by rectal Dieulafoy's lesion: Case reports and literature review. Medicine (Baltimore) 2022; 101:e32031. [PMID: 36482623 PMCID: PMC9726342 DOI: 10.1097/md.0000000000032031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Dieulafoy's lesion are relatively rare and can cause severe gastrointestinal bleeding. A Dieulafoy's lesion is defined as an artery that erodes the overlying epithelium without the presence of an ulcer. Bleeding in Dieulafoy's lesion predominantly involves the proximal stomach and upper gastrointestinal tract and is rarely observed in the lower gastrointestinal tract. PATIENT CONCERNS Case 1 was a 58-year-old woman complaining of sudden headache and vomiting who was diagnosed with subarachnoid hemorrhage. She underwent transcatheter embolization for intracranial aneurysm treatment but had an acute profuse hematochezia on the 11th day of admission. Case 2 was a 63-year-old man admitted to the respiratory intensive care unit because of fever with altered consciousness level for a week. He was diagnosed with advanced lung cancer that had metastasized to multiple organs one month prior. On the third day of admission, he had an attack of profuse hematochezia, and quickly developed shock and apathy. DIAGNOSIS Both patients were diagnosed with actively bleeding rectal Dieulafoy's lesion by bedside emergency colonoscopy. INTERVENTIONS Endoscopic hemostatic clipping was performed in 2 patients. OUTCOMES Hemostasis was successfully achieved in these 2 patients, and there was no recurrence of symptoms during follow-up. CONCLUSIONS We propose that hemostatic clipping is one of the options in the treatment of rectal Dieulafoy's lesions.
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Affiliation(s)
- Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu Lei
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Hou
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Nianjun Chen
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jingmei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qiaozhen Guo
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- * Correspondence: Wei Yan, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Avenue, Wuhan 430030, People’s Republic of China (e-mail: )
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Dokmak A, Muso E. Gastrointestinal Bleeding from Dieulafoy's Lesion in the Cecum. Case Rep Gastroenterol 2022; 16:601-606. [PMID: 36636361 PMCID: PMC9830308 DOI: 10.1159/000525740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Dieulafoy's lesion is a rare cause of gastrointestinal (GI) bleeding comprising approximately 2% of all acute GI bleeds. It is an abnormal submucosal artery that has a tortuous course before protruding through the mucosa and leading to hemorrhage. Dieulafoy's lesions are most commonly located in the upper GI tract within the lesser curvature of the stomach. Lower GI tract Dieulafoy's lesions are remarkably rare. Our case describes an elderly gentleman who presented with fatigue and dyspnea several days prior to experiencing any evidence of GI bleeding. Initial laboratory investigation revealed severe anemia, requiring packed red blood cell transfusion. Endoscopic examination revealed a cecal Dieulafoy's lesion with active spurting of blood. Hemostasis was achieved through local epinephrine injection and hemostatic clipping. Previously reported cases of cecal Dieulafoy's lesions involve variable presentations including hematochezia, melena, or bright red blood per rectum. These lesions can be treated by angiography, surgically, or endoscopically via techniques that include epinephrine or ethanol injection, argon plasma coagulation, heater probe coagulation, hemostatic clips, or band ligation. Dieulafoy's lesions of the lower GI tract should be considered when no clear culprit is discovered, particularly with the concomitant use of antiplatelet agents and anticoagulants.
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Affiliation(s)
- Amr Dokmak
- Department of Hospital Medicine, Catholic Medical Center, Manchester, New Hampshire, USA,*Amr Dokmak,
| | - Ergen Muso
- Division of Gastroenterology, Catholic Medical Center, Manchester, New Hampshire, USA
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Muacevic A, Adler JR, Loomis III JR, Thomas JA. Diagnosis and Treatment of a Recurrent Bleeding Dieulafoy's Lesion: A Case Report. Cureus 2022; 14:e32051. [PMID: 36600857 PMCID: PMC9802011 DOI: 10.7759/cureus.32051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Dieulafoy's lesions are uncommon causes of upper gastrointestinal bleeding (UGIB) that pose a life-threatening risk if not diagnosed promptly and treated appropriately. These lesions are composed of enlarged submucosal blood vessels that bleed despite any gross abnormality. Early intervention with esophagogastroduodenoscopy (EGD) is necessary to avoid more invasive treatment with angiogram embolization or surgical removal. This paper aims to discuss a case regarding a patient with difficult-to-control recurrent bleeding from a Dieulafoy's lesion located in the gastric fundus of a previously healthy 60-year-old female. This case highlights the need for dual therapy and special considerations regarding antiplatelet medications and supplements when treating patients with Dieulafoy's lesions.
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Rummaan A, Lee I, Rattehalli D, Kumar P, Ishaq S. Stitch in time saves nine. Frontline Gastroenterol 2022; 14:265-266. [PMID: 37056323 PMCID: PMC10086700 DOI: 10.1136/flgastro-2022-102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Affiliation(s)
- Aisha Rummaan
- Endoscopy Department, Dudley Group of Hospital, Dudley, UK
| | - Irene Lee
- Endoscopy Department, Dudley Group of Hospital, Dudley, UK
| | | | - Prajesh Kumar
- Endoscopy Department, Dudley Group of Hospital, Dudley, UK
| | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group NHS Foundation Trust, Dudley, UK
- Department of health and Science, Birmingham City University, Birmingham, UK
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45
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Takeyama J. Meckel's Diverticulum with Dieulafoy's Lesion: A Cause of Severe Hematochezia. Fetal Pediatr Pathol 2022; 41:865-870. [PMID: 34652969 DOI: 10.1080/15513815.2021.1989529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meckel's diverticulum (MD) is a remnant of the omphalomesenteric duct. Although the majority of MD are asymptomatic, it can present with severe hematochezia. Hematochezia is generally considered to result from a peptic ulcer caused by ectopic gastric mucosa in MD. However, this hypothesis has not been proved. METHODS 10 cases of surgically resected MD initially presenting with severe hematochezia were histologically examined. RESULTS Ectopic gastric mucosa was present in 9 cases, two of which also contained ectopic pancreas. No ectopic tissue was found in one case, which shows that bleeding can occur in MD without ectopic gastric mucosa. In addition, a rupture of aberrant submucosal arterioles through the overlying mucosa, a vascular abnormality called Dieulafoy's lesion, was detected in all the 10 cases. CONCLUSION This study suggests that the actual cause of massive bleeding in MD is not a peptic ulcer, but Dieulafoy's lesion.
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Affiliation(s)
- Junji Takeyama
- Department of Pathology, Miyagi Children's Hospital, Sendai, Japan
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Masuda H, Gill AJ, Samra JS. A Rare Cause of Hemoperitoneum. Gastroenterology 2022; 163:e8-e10. [PMID: 35248540 DOI: 10.1053/j.gastro.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Hiro Masuda
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - Anthony J Gill
- Northern Clinical School, University of Sydney, Sydney, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
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Dixit VK, Sahu MK, Venkatesh V, Bhargav VY, Kumar V, Pateriya MB, Venkataraman J. Gastrointestinal Emergencies and the Role of Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractMany gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.
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Affiliation(s)
- Vinod Kumar Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Varanasi Yugandhar Bhargav
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vinod Kumar
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mayank Bhushan Pateriya
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Barrantes Murillo DF, Tillson M, Koehler JW, Sandey M. Case report: The first description of a Dieulafoy's lesion in the gastric mucosa of a dog. Front Vet Sci 2022; 9:932435. [PMID: 36072394 PMCID: PMC9441867 DOI: 10.3389/fvets.2022.932435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
An approximately 12-year-old, 31 kg, male neutered Labrador Retriever was presented to the referring hospital with an acute onset (less than 1 day) of hematemesis and melena. The dog was treated supportively for a presumptive gastric ulcer for 4 days with intravenous fluids, gastro protectants, such as pantoprazole, misoprostol, sucralfate, and barium, as well as an anti-emetic (maropitant) and analgesics (fentanyl, gabapentin, and tramadol). Throughout medical management, the dog continued to require blood transfusions approximately every 24 h. Given the poor medical response, the patient was subjected to an exploratory laparotomy. During surgery, a grossly raised, blister-like lesion on the mucosal surface of the stomach was appreciated on the lesser curvature of the stomach. A partial gastrectomy was performed, and the segment was submitted for histological evaluation. Histologically, there were multiple, tortuous, medium-caliber muscular arteries (>1.0 mm in diameter) in the submucosa. A single large-caliber artery (>0.75 mm in diameter) containing a partially occlusive thrombus extruded through the mucosa and projected on the ulcerated surface. The patient's signs were similar clinically and histopathologically to Dieulafoy's lesion in people. A Dieulafoy's lesion is a potentially life-threatening disorder that causes gastrointestinal (GI) hemorrhage. This lesion is characterized by a dilated, large-caliber, aberrant submucosal artery that erodes through the epithelium and ruptures, resulting in massive and potentially fatal hemorrhage. This lesion has never been documented previously in a dog.
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Affiliation(s)
| | - Michael Tillson
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Jennifer W. Koehler
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
| | - Maninder Sandey
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
- *Correspondence: Maninder Sandey
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Huynh TM, Le QD, Luu MN, Nguyen TTH, Bui QN, Mai APT, Tran THD, Tran HM, Vo CHM, Quach DT. A Multidisciplinary approach to treat massive recurrent hematochezia from a jejunal Dieulafoy lesion: A case report. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022; 11:135-138. [DOI: 10.18528/ijgii220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 09/25/2023] Open
Affiliation(s)
- Tien Manh Huynh
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Mai Ngoc Luu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | | | | | | | | | | | | | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
- Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
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Miyao M, Kawai C, Kotani H, Minami H, Abiru H, Hamayasu H, Yamamoto A, Tamaki K. Fatal Dieulafoy lesion with IgG4-related disease: An autopsy case report. Leg Med (Tokyo) 2022; 57:102059. [DOI: 10.1016/j.legalmed.2022.102059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 02/07/2023]
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