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Dieulafoy’s Lesion (Dieulafoy’s Disease) : Causes, Symptoms, & Treatment

Dieulafoy Lesion (Dieulafoy’s Disease) : Definition, Etiology, Signs, Symptoms, Diagnosis, Management, & Prognosis

Definition

  • Dieulafoy’s disease is a developmental malformation in which there is gastric arterio-venous malformation
    seen in submucosal vessels which is covered by apparently normal mucosa.
  • It occurs in proximal stomach near OG junction (within 6 cm) along lesser curve (80% of cases).
  • More common in male (male > female).
  • More common at mid age.

Clinical Features

  • Hematemesis
  • Malaena
  • Anemia

Bleeding often may be severe and torrential.
Vasculitis or atheroma are absent in the vessel.

A large 1-3 mm tortuous abnormal submucosal artery  (AVM) is the cause, which due to its pulsation erodes the mucosa to expose itself to acid which further erodes the artery causing bleeding.

Treatment

1. Endoscopic thermoprobe coagulation

  • Endoscopy and endoscopic therapy or excision of the lesion is required.

2. Angiographic therapy

Angiography can be done to confirm the disease and to do the therapeutic embolism using gel foam.

3. Gastrectomy & gastric wedge resection

  • Failure of endoscopic or angiographic therapy needs gastrectomy & excision of entire lesion-gastric wedge resection.
  • It can be done by open / laparoscopic approach.
  • Prior endoscopic tattooing is mandatory to identify the lesion during resection.

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