Dieulafoy ulcer

Classification according to ICD-10
K25	Gastric ulcer
K25.0	Acute gastric ulcer with bleeding
ICD-10 online (WHO version 2019)

A Dieulafoy ulcer ( Dieulafoy lesion or exulceratio simplex ) is a rare form of bleeding gastric ulcer ( gastric ulcer ) that can arise from a congenital abnormality of blood vessels in the stomach wall.

The Dieulafoy ulcer is named after the French doctor Paul Georges Dieulafoy (1839-1911), who first described the phenomenon in 1898 and referred to it as exulceratio simplex .

frequency

Dieulafoy ulcer is a rare disease and makes up less than one percent of all gastric ulcers. It typically occurs in middle age, and men are more likely to suffer from it than women. An association with terminal liver disease is discussed.

Disease emergence

In Dieulafoy's ulcer, an arteriole or small artery is dilated up to about ten times the normal diameter of comparable vessels (1 to 5 mm), often twisted like a screw, and is much closer to the layers of the stomach wall near the mucous membrane. The vessel, which is widened and thinner-walled like an aneurysm , extends to the muscle layer of the gastric mucosa ( muscularis mucosae ), where, in the case of gastric mucosal inflammation, the vessel can very easily rupture with life-threatening bleeding. It is believed that the mechanical disturbance of the gastric mucosa, which is caused by the pulsating vessel, contributes significantly to the development of the ulcer.

localization

In principle, a Dieulafoy ulcer can develop anywhere on the gastric mucosa, but predominantly in the area of ​​the stomach entrance 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 are expressed as gastrointestinal bleeding , vomiting of blood and possible symptoms of shock (volume deficiency shock ). About five percent of gastrointestinal bleeding in adults is attributed to Dieulafoy ulcer. On an endoscopic examination, the abnormality may be a chance finding that can then be treated before bleeding occurs.

therapy

Endoscopic hemostasis using a clip is the primary treatment method indicated. The obliteration of the vessel is considered less effective. If these methods fail, rubber band ligation may be attempted.

In the event of recurrent bleeding or if endoscopic treatment is impossible, surgical treatment must be considered. The method of choice is the excision of the part of the wall bearing the lesion.

literature

• D. Schilling et al .: Endoscopic diagnosis and therapy as well as the long-term course of Dieulafoy ulcer hemorrhage. In: Dtsch. Med. Wochenschr. (1999) 124 (14), pp. 419-423. PMID 10230383
• D. Blecker et al .: Dieulafoy's lesion of the small bowel causing massive gastrointestinal bleeding: two case reports and literature review. In: Am. J. Gastroenterol. (2001) 96 (3), pp. 902-905. PMID 11280574 .
• G. Dieulafoy: Exulceratio simplex: Leçons 1-3. In: G. Dieulafoy (ed.): Clinique medicale de l'Hotel Dieu de Paris . Masson et Cie, Paris 1898, pp. 1-38.

Individual evidence

1. ↑ ^{a b c} Peter Layer, Ulrich Rosien (Ed.): Practical gastroenterology. 4th edition. Munich 2011, p. 136f.
2. ↑ J. Akhras, P. Patel, M. Tobi: Dieulafoy's lesion-like bleeding: an underrecognized cause of upper gastrointestinal hemorrhage in patients with advanced liver disease. In: Dig Dis Sci. 2007 Mar; 52 (3), pp. 722-726. PMID 17237996

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