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What is a Dieulafoy’s Lesion?
Dieulafoy ’s lesion is a disease where the affected role develop large twisted arteriole usually in the wall of the stomach ( 1 , 2 , 4 ) . There is erosion and bleeding from this twisted arteriole and this lesion can modernize in any part of the gastrointestinal nerve tract and can also sometimes lead to gastric hemorrhage . About less than 4 % of all GI haemorrhage in adults fall out as a resolution of Dieulafoy ’s lesion(3 ) .
Who Discovered Dieulafoy’s Lesion?
This consideration was nominate after the Gallic Doctor Paul G. Dieulafoy , who characterise this disease(5 ) . Dieulafoy ’s lesion is also known as “ aneurism ” of the gastric vas or “ caliber - persistent artery . ” However , Dieulafoy ’s lesion is considered as developmental malformations , instead of degenerative changes as get a line in even aneurysms .
What is the Cause of Dieulafoy’s Lesion?
An abnormally large and twisted arteriola present under the GI mucosa induce Dieulafoy ’s lesion and there is bleeding from the wound without any ulceration or other mucosal abnormality . The sizing of these twisted blood vessels can range from 1 to 3 mm . It is thought that the pulse from the hypertrophied arteriola causes cutting of the mucosa ( erosion ) in that area result in exposure of the tumid capillary artery and subsequent bleeding .
As play off to peptic ulcer disease , there is no history ofNSAIDsuse or alcohol contumely in patient suffering from Dieulafoy ’s lesion . This stipulation can touch on any area of the gastrointestinal tract and has also been visit in thegallbladder .
Pathophysiology of Dieulafoy’s Lesions
A undivided large tortuous arterial blood vessel is the primary characteristic feature article of Dieulafoy ’s wound . This lesion is present in grinder - mucosa and only has a arm range in width of 1 to 5 millimeter . Dieulafoy ’s wound leech within the GI nerve pathway via a small defect in the mucous membrane that is due to erosion due to protrusion of the pulsatile capillary artery in the sub - mucosal open .
The most common location for Dieulafoy ’s wound is the duodenum followed by the colon , after which surgical Anastomosis ; then the jejunum follow by less unremarkably in the esophagus ( about 1 % ) .
More than half of the Dieulafoy ’s lesions develop within 6 cm of the gastroesophageal juncture that is in the upper part of the venter and less usually in the lesser curve . Dieulafoy ’s wound outside of the stomach is uncommon ; however , have been reported more frequently recently . This can be due to the increase cognisance of this disease . The pathologic features of the Dieulafoy ’s lesions found outside the stomach is basically the same that is seen in those present in the GI tract .
What are the Signs & Symptoms of Dieulafoy’s Lesion?
Dieulafoy ’s lesion is commonly asymptomatic ; symptoms when present consist of painless hemorrhage with hematemesis and/or melena ( black stools ) . Less commonly rectal bleeding can come about due to Dieulafoy ’s wound or rarely there can be smoothing iron deficiency anaemia picture in the patient . Patient having Dieulafoy ’s lesion usually does not present with any gastrointestinal symptoms ( nausea , abdominal botheration etc . ) before the hemorrhage .
Some of the symptom seen in Dieulafoy ’s lesion admit :
Some rare symptoms occurring as a result of Dieulafoy ’s lesion present in gallbladder consist ofupper abdominal pain , commonly in the right upper quarter-circle or epigastric region . Even though Dieulafoy ’s lesions in gall bladder often come about with genus Anemia , they usually do not induce inordinate bleeding ( haematemesis , hematochezia , melaena , etc ) .
Epidemiology of Dieulafoy’s Lesion
About more than 1 % of gastrointestinal bleeding is due to Dieulafoy ’s lesions . Dieulafoy ’s lesion is also commonly get word to develop in patients over the age of 50 years and make multiple co - morbidity , such as hypertension , chronic kidney disease , cardiovascular disease anddiabetes(6 ) . Men are twice at risk for developing these wound than women(5 ) .
How is the Diagnosis of Dieulafoy’s Lesion Made?
It is difficult to name Dieulafoy ’s wound , because of the intermittent nature of the bleeding(5 ) . During an endoscopic valuation and most commonly the upper endoscopy , the diagnosis of Dieulafoy ’s lesion is made . Dieulafoy ’s wound present in the colon or the terminal ileum can be diagnose during colonoscopy . It is difficult to identify Dieulafoy ’s lesions and multiple evaluation with endoscopy are needed for the right diagnosis . Angiography can also help with diagnosis of Dieulafoy ’s wound ; however , this only helps in identify fighting hemorrhage occurring during the fourth dimension of the routine .
After Dieulafoy ’s lesion has been note , the mucosa side by side to the Dieulafoy ’s wound will be injected with ink ; this will help in identifying the site of the Dieulafoy ’s wound if there is any recurrent hemorrhage in the future .
What is the Treatment for Dieulafoy’s Lesion?
Dieulafoy ’s wound is diagnose as well as treat via endoscopy . Other than this , angiography or endoscopic echography can also be beneficial with the diagnosis of the Dieulafoy ’s lesion .
The endoscopic techniques for treating Dieulafoy ’s lesion consist of : epinephrine injection followed by monopolar or bipolar electrocoagulation ; injectant sclerotherapy ; heater probe ; laser photocoagulation ; stria or hemoclipping(7 ) .
If the patient role has stubborn or persistent bleeding , then interventional radiology needs to be consulted for an angiogram along with sub - selective embolization .
What is the Prognosis for Dieulafoy’s Lesion?
The death pace for Dieulafoy ’s used to be high before the advent of endoscopy(7 ) . antecedently the only discourse option for Dieulafoy ’s lesion used to be candid surgical procedure ; however , with today ’s newfangled treatment options , the prognosis of Dieulafoy ’s lesion is expert with long term controlling of the hemorrhage see in about 85 to 90 % of the patients(7 ) .
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