A 64-Year-Old Woman With Recurrent Gastrointestinal Bleeding

Juan Carlos Munoz, MD; Matthew S. Cole, MD, MPH

Disclosures

March 31, 2016

Discussion

The findings in this case are consistent with a Dieulafoy lesion of the small bowel, probably in the midjejunum (Figures 1 and 2). Dieulafoy lesion is also known as exulceratio simplex, caliber-persistent artery, gastric arteriosclerosis, submucosal arterial malformation, and cirsoid aneurysm of the gastric vessels. Unlike most other aneurysms, Dieulafoy lesions are thought to be developmental mal uncommon condition, accounting for 1%-5% of all cases of acute gastrointestinal bleeding in adults (depending on the series). In approximately 4%-9% of cases of massive upper gastrointestinal hemorrhage, no demonstrable cause can be found; Dieulafoy lesion is thought to be the cause of acute and chronic upper gastrointestinal bleeding in approximately 1%-2% of these cases. It is a well-recognized cause of recurrent, intermittent, and life-threatening bleeding from the gastrointestinal tract, and it results from the rupture of an unexposed submucosal artery.[3,5,6,7,8,9]

In a Dieulafoy lesion, the submucosal artery does not undergo normal ramification into mucosal capillary microvessels. Instead, a caliber-persistent artery at the muscularis mucosae is seen. It is characterized by subintimal fibrosis of the artery and an absence of inflammation at the edge of the mucosal defect. As a result, the caliber of the artery is in the range of 1-5 mm. This is approximately 10 times the normal caliber of mucosal capillaries.

Previous descriptions of Dieulafoy lesions emphasized a predilection for the proximal stomach at 6 cm from the gastroesophageal junction, most often located along the lesser curvature (80%-85%); however, it has been found in all areas of the gastrointestinal tract, including the colon and rectum (10%), esophagus (2%), and small intestine (2%).[6]

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