The Diagnostic Dilemma of Dieulafoy’s Lesion

Abstract

Dieulafoy’s lesion (DL) is a relatively rare condition which carries a significantly high risk for mortality. A tortuous large arteriole in the wall of the stomach can result in significant gastrointestinal (GI) hemorrhage which can result in detrimental complications. Although it only accounts for about 1% of all GI bleeding, it has been considered to be one of the most underrecognized conditions. This train of thought may unfortunately be related to the difficulty in its diagnosis. After conducting a Medline search of the medical literature, with a focus on current PubMed articles, a thorough examination of updated diagnostic and treatment approaches was compared. Diagnostic techniques in the analysis and treatment of DLs continue to be limited to this day. Endoscopy remains as the main diagnostic and therapeutic tool; however, it continues to have its limitations. Other alternatives include but are not limited to angiography and surgical interventions which at times can be more successful. Diagnostic improvements and research for the detection of DL continue to advance; however, they remain limited in their capabilities. Further analysis and workup needs to be conducted in order to reduce hospital stay and improve survival.

Dieulafoy’s lesion of the duodenum: a comparative review of 37 cases

“…The risk of rebleeding from the Dieulafoy’s lesion has been reported to vary from 9% to 40% 57. When rebleeding is encountered, the diagnostic and treatment algorithm remains the same as with the initial presentation.…”

Dieulafoy’s lesion of the colon and rectum: a case series and literature review

“…This disease is characterised by small submucosal arteriole that erodes the overlying mucosa and cause severe gastrointestinal bleeding without an evidence of primary ulcer, erosion or aneurysm 1 2. It frequently involves the male patient population at the fifth decade of life without any familial predisposition 3. The most common and classic location for this lesion is fundus area of stomach 3.…”

“…It frequently involves the male patient population at the fifth decade of life without any familial predisposition 3. The most common and classic location for this lesion is fundus area of stomach 3. There are reports of the lesion involving the oesophagus, duodenum, ileum and jejunum 4–11.…”

“…Dieulafoy’s lesion accounts for 1%–2% of all gastrointestinal haemorrhage; however, it has been considered to be one of the most under-recognised conditions due to the subtlety of the lesion 3. Endoscopy remains the first diagnostic test.…”

“…Endoscopy remains the first diagnostic test. Contrast-enhance CT, angiography and surgical interventions are other diagnostic approaches in patients with a Dieulafoy’s lesion, which at times can be more successful in difficult-to-diagnose cases 3. Although there are no standard guidelines, endoscopy has significantly impacted the management of the Dieulafoy’s lesion, with methods like endoscopic injection sclerotherapy, thermocoagulation and mechanical therapy 3 4.…”