Dieulafoy's lesion

A Dieulafoy ulcer ( Dieulafoy lesion or Exulceratio simplex) is a rare form of a bleeding gastric ulcer ( gastric ulcer ) that may arise in a congenital anomaly of blood vessels in the stomach wall.

The Dieulafoy ulcer is named after the French physician Paul Georges Dieulafoy (1839-1911) appointed who first described the phenomenon in 1898 and as Exulceratio simplex designated.

Frequency

The Dieulafoy ulcer is a rare cause. It makes up less than one percent of all stomach ulcers. Typically, the disease occurs in middle age. Men more likely to suffer it than women. An association with terminal liver disease is discussed.

Pathogenesis

Dieulafoy the ulcer a arteriole and small artery is dilated to about ten times the normal diameter similar vessels (1 to 5 mm), often twisted helically and is situated substantially closer to the layers close to the mucosa of the gastric wall. The similarly an aneurysm enlarged and thin-walled vessel extends to the muscle layer of the gastric mucosa ( muscularis mucosae), where in case of gastritis can very easily lead to a rupture of the vessel with life-threatening bleeding. It is believed that the mechanical disturbance of the gastric mucosa, which is caused by the pulsating vessel, the origin of the ulcer contributes significantly.

Localization

In principle, a Dieulafoy ulcer occur at all points of the gastric mucosa, but predominantly in the area of the cardia and the lesser curvature. A Dieulafoy ulcer can also occur outside of the stomach, for example, in the colon, small intestine, duodenum, or esophagus.

Symptoms and diagnosis

The symptoms manifest themselves in gastrointestinal bleeding, vomiting blood and possible symptoms of shock ( hypovolemia shock). About five percent of gastrointestinal bleeding in adults are attributed to a Dieulafoy ulcer. In an endoscopic examination abnormality may be a chance finding, which can then be treated before the occurrence of bleeding.

Therapy

Endoscopic hemostasis by means of clamp (clip) is the primary care -indexed method. The obliteration of the vessel is considered to be less effective. Upon failure of these methods a rubber band ligation can be attempted.

When rebleeding or inability to supply endoscopic surgical treatment must be considered. The method of choice is the excision of the lesion portion of load-bearing wall.