Massive lower digestive bleeding caused by jejunal aneurysm - 23/08/11
Doi : 10.1016/j.gie.2008.07.039
| Commentary Dieulafoy’s lesion was named after the French surgeon Paul Georges Dieulafoy, who described it in his paper “Exulceratio Simplex” in 1898. While the name Dieulafoy is firmly attached to this lesion, Dieulafoy’s triad in acute appendicitis is less known: hyperesthesia of the skin, tenderness, and guarding over McBurney’s point. The manuscript title of Dieulafoy’s landmark paper focused on the mucosal/submucosal erosion resulting from the pressure of the pulsating subjacent artery, but the essential abnormality is a “caliber-persistent” submucosal vessel that maintains a large diameter of up to 10 times normal without branching. This arterial lesion also is called a cirsoid aneurysm, which is anatomically paradoxical because the word cirsoid is derived from the Greek for varicoid or varix-like (kirsos, varix + eidos, appearance). I guess the tortuous nature of the artery was sufficiently redolent of a serpiginous varix to trump any potential anatomic confusion. Extragastric Dieulafoy lesions are uncommon but increasingly recognized and reported in the duodenum, colon, jejunum and esophagus. This patient was emergently ill, so angiographic diagnosis and treatment were not possible. Kudos to the authors for a successful outcome. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2009
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 69 - N° 2
P. 338-339 - février 2009 Retour au numéro
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