Bleeding sigmoid colonic Dieulafoy lesion (with video)

 CommentaryThe Dieulafoy lesion was described by the French physician/surgeon Paul Georges Dieulafoy as exulceratio simplex, now known to be caused by a caliber-persistent vessel that neither tapers nor branches and that causes ulceration of the overlying mucosa, probably by pressure necrosis. Less well known are his contributions to appendicitis (Dieulafoy's triad: hyperesthesia of the skin, tenderness and guarding over McBurney's point), and his pumplike apparatus to assist thoracentesis. The vast majority of Dieulafoy lesions are located within 6 cm of the cardioesophageal junction, and they cause hemetemesis that often is massive. Extragastric Dieulafoy lesions have been described in the esophagus, small intestine, and colorectum, and virtually no area of hollow viscera is spared from manifesting this developmental anomaly. All manner of endoscopic therapy to halt bleeding has been used successfully with this lesion, and the best one to use is the one with which the user feels most comfortable. Consider Dieulafoy lesion in any patient with rapid or profound bleeding, when you see a visible vessel or adherent clot, and when a pulsatile stream crosses your field of view. Dieulafoy said that “medical therapy has no role in the treatment of appendicitis”; he might have said the same thing about the lesion later to bear his name.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02178-6

doi: 10.1016/j.gie.2009.06.024

© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.