Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

A rare cause of upper gastrointestinal bleeding

George Rakovich
CMAJ April 25, 2006 174 (9) 1261; DOI: https://doi.org/10.1503/cmaj.051600
George Rakovich
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

A 49-year-old woman with chronic obstructive pulmonary disease, Barrett's esophagus and type 2 diabetes who was taking single-dose ASA daily and had recently undergone cholecystectomy presented to the emergency department with sudden onset of massive hematemesis and shock. After aggressive resuscitation, she underwent emergent upper gastrointestinal endoscopy. The bulb and descending duodenum appeared normal. The stomach was full of fresh blood and clot that had to be cleared. The body and antrum showed moderate erosive gastritis. Close inspection of the lesser curvature near the cardia revealed a small clot and a visible vessel within a tiny mucosal defect surrounded by normal mucosa (Fig. 1); there was no active bleeding. The characteristics of the lesion and the typical location led to a diagnosis of Dieulafoy's lesion. The lesion and surrounding tissue were injected with epinephrine. Repeat endoscopy at 1 week showed partial healing, and the patient was discharged in good condition with a prescription for oral therapy with a proton pump inhibitor. Endoscopy at 6 months revealed complete healing.

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

Fig. 1: Dieulafoy's lesion seen on lesser curvature of stomach.

Dieulafoy's lesion arises from an enlarged submucosal artery that runs too close to the gastrointestinal mucosa. The pathophysiology is not well understood but may involve erosion of the mucosa by pressure from the artery and subsequent rupture of the vessel. Dieulafoy's lesion is responsible for about 2% of acute upper gastrointestinal bleeds (Table 1).1–3 This anomaly may develop anywhere in the gastrointestinal tract, but it usually occurs in the proximal stomach, often on the lesser curvature within 6 cm of the gastroesophageal junction.2,3 This may be because the lesser curvature is not perfused by a submucosal plexus but rather derives its blood supply directly from tributaries of the right and left gastric arteries.

View this table:
  • View inline
  • View popup
  • Download powerpoint

Table 1.

A patient with Dieulafoy's lesion usually presents with acute massive upper gastrointestinal bleeding; the median age at presentation is in the sixth decade. The prevalence of asymptomatic lesions is unknown. Anemia is rare. Comorbidities, especially cardiac and pulmonary disease, are common.2,3 Some have suggested an association with peptic ulcer disease and mucosal irritants such as NSAIDs and alcohol; however, the role of these factors in the pathogenesis of Dieulafoy's lesion and the risk of hemorrhage remains to be defined.

Diagnosis is often difficult owing to the lesion's small size and the intermittent nature of the bleeding. Dieulafoy's lesion should be suspected if there is persistent hemorrhage of unknown origin. Historically, surgical treatment was associated with high morbidity and mortality; however, the advent of therapeutic endoscopy has revolutionized diagnosis and treatment and dramatically improved outcomes. The rate of initial endoscopic diagnosis and the rate of permanent hemostasis are both over 90%.2 Injection sclerotherapy, thermal probes, cautery, laser, rubber-band ligation and clips have all been used successfully.2,3 Recurrent bleeding after treatment is rare.2

Footnotes

  • Competing interests: None declared.

REFERENCES

  1. 1.↵
    Palmer K. Management of haematemesis and melaena [review]. Postgrad Med J 2004;80(945):399-404.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    Yilmaz M, Ozutemiz O, Karasu Z, et al. Endoscopic injection therapy of bleeding Dieulafoy lesion of the stomach. Hepatogastroenterology 2005;52(65):1622-5.
    OpenUrlPubMed
  3. 3.↵
    Schmulewitz N, Baillie J. Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center. Am J Gastroenterol 2001;96(6):1688-94.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 174 (9)
CMAJ
Vol. 174, Issue 9
25 Apr 2006
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A rare cause of upper gastrointestinal bleeding
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
A rare cause of upper gastrointestinal bleeding
George Rakovich
CMAJ Apr 2006, 174 (9) 1261; DOI: 10.1503/cmaj.051600

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
A rare cause of upper gastrointestinal bleeding
George Rakovich
CMAJ Apr 2006, 174 (9) 1261; DOI: 10.1503/cmaj.051600
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • REFERENCES
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights of this issue
  • Dans ce numéro
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • A blistering variant of phlegmasia cerulea dolens from underlying squamous cell lung cancer
  • Parechovirus infections in infants
  • Radiation dermatitis in a patient treated for hepatocarcinoma
Show more Practice

Similar Articles

Collections

  • Topics
    • Gastroenterology
    • Surgery: adult

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire