The lesion in Dieulafoy's disease consists of a submucosal ectatic artery in the gastrointestinal tract. It is larger than the vessels usually in that area. It can occur in any part of the GI tract, although most frequently it is in the stomach.¹ The protuberant artery causes brisk bleeding with little or no surrounding ulceration. The aetiology of the ectatic vessel and the cause of bleeding is unknown.

Dieulafoy was a French Surgeon and was the first to describe three cases at the end of the 18th century.

Commonest sites²

• Proximal stomach
• Small intestine - both jejunum and ileum have been involved³
• Colon
• Rectum²
• More rare - oesophagus

Epidemiology⁴

The incidence of Dieulafoy lesion leading to GIT haemorrhage ranges from 0.5% to 14%, depending upon the study. It is commoner in men and presents around 50 years of age.

Presentation

• Bleeding - upper GIT or lower GIT
• Abdominal pain is uncommon
• Haemodynamic compromise

Investigations

Endoscopy, although repeated endoscopy may be required - especially if the lesion is not actively bleeding.¹

Management²

• Resuscitation with fluids, blood etc.
• Endoscopic occlusion of the vessel, either by sclerotherapy, electrocautery or laser. Endoscopic examination and management requires careful inspection as the lesions can be easily missed.
• Rarely if the lesion can not be identified and the patient continues to bleed then surgical exploration may be necessary.
• Band ligation has also been used to treat Dieulafoy lesions with some success.⁵

Prognosis

The haemorrhage is usually difficult to manage conservatively and can be fatal. However, with meticulous examination at endoscopy the outcome is much improved.