Bleeding from a gastric Dieulafoy lesion
A 70-year-old man was admitted with haematemesis with no history of non-steroidal anti-inflammatory drugs, aspirin or alcohol use. Oesophagogastroduodenoscopy showed the characteristic appearance of Dieulafoy lesions—tiny punctuate lesions along the lesser curve of the stomach with normal underlying mucosa. A Dieulafoy lesion is a dilated tortuous pinpoint non-ulcerated submucosal arterial lesion, more common in men than in women (2:1), common in the upper stomach, but can occur in any part of intestine. It is an uncommon cause (1–2%) of massive, recurrent upper gastrointestinal bleeding1 that may require repeat endoscopies.
Awareness of the lesion and an experienced endoscopist are important in helping to reach the correct diagnosis. Various treatment strategies include local adrenalin injection, thermocoagulation, laser treatment, electrocautery and band ligation. Tattooing with India ink marks the site of Dieulafoy lesion to identify the site in case the bleeding recurs despite treatment.
This article has been adapted from Bleeding from a gastric Dieulafoy lesion Emergency Medicine Journal 2007;24:520
Competing interests: None declared.
The photograph supplied is an endoscopic picture of the patient. I believe this may negate the need for patient consent in this case.