Lower Gastrointestinal Bleeding from a Dieulafoy Lesion in the Anorectal Junction


Dieulafoy's lesion is a medical condition that is most generally characterized by a large tortuous arteriole in the stomach wall (submucosal), which erodes and bleeds. It can occur in any section of the gastrointestinal tract. It can cause stomach hemorrhage but is very rare. It is known to cause less than 5 percent of all adult gastrointestinal bleeds.

Diagnosis: Due to the irregular pattern of bleeding a Dieulafoy's lesion is difficult to diagnose. The lesion caused by Dieulafoy is normally detected during endoscopic examination, generally during upper endoscopy. During colonoscopy, lesions which affect the colon or end of the small intestine (terminal ileum) may be diagnosed. Lesions of Dieulafoy are not easily identified and thus multiple endoscopy tests may be required. Angiography can be useful for diagnosis, but this only detects bleeding that occurs significantly during the time of the examination.

Cause: The lesion of a Dieulafoy is caused by an abnormally large blood vessel (arteriole) under the gastrointestinal mucosa (submucosal) that bleeds in the absence of any ulcer, erosion, or other mucosal abnormality. The thickness of those blood vessels varies between 1 and 3 mm. It may be that the pulsation from the swollen vessels contributes to mucosal thinning at that spot, resulting in vessel exposure and eventual hemorrhage.

Dieulafoy's lesions are one of the rarest causes of gastrointestinal bleeding which threatens lifestyle. These lesions account for 1-2% of the causes of gastrointestinal bleeding, especially in cases where the source cannot be established

Dieulafoy’s lesion is a well-recognized cause of gastrointestinal bleeding and is twice frequent in men than women. It may occur at any age, but more typically in the elderly in conjunction with co-morbidities, such as heart disease and renal failure

In the submucosa of the stomach wall which erodes and bleeds, Dieulafoy's lesion is characterized by large tortuous arteriole most commonly present. It can cause stomach haemorrhage but it is fairly rare. There are various hypotheses about Dieulafoy's lesion pathophysiology

Dieulafoy’s lesion are rare causes of lower gastrointestinal bleeding, which can easily be missed in the lower rectum. Dieulfoy's lesions in any gastrointestinal bleeding should be included in the differential diagnosis with a high level of suspicion. Endoscopy has proved to be a very effective method for the treatment and control of these lesions.

Authors can submit their manuscript related topics like Gastrointestinal Bleeding, Dieulafoy lesion and Anorectal bleeding by the email to our Journal Mail IDs trauma@emedicalsci.com or jtac@peerjournal.org  

For further queries you can contact us any time 24×7 help line service available for the Journal of Trauma & Acute Care

Best Regards,
Editorial Team