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Tan L, Gilbert JD, Byard RW. Fatal exulceratio simplex (dieulafoy lesion) - a case report and review. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00895-4. [PMID: 39298100 DOI: 10.1007/s12024-024-00895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 09/21/2024]
Abstract
A 64-year-old man involved in a low-speed vehicle crash was found at autopsy to have altered blood extending from his stomach to his rectum. Within the stomach a small arterial vessel opened onto the mucosa of the posterior wall of the antrum adjacent to the pylorus with no adjacent mucosal ulceration or malignancy. Histologic sections showed the typical appearances of a Dieulafoy lesion with a tortuous small arteriole within the submucosa extending to the gastric lumen with an overlying cap of recently formed clot. There were no injuries attributable to the vehicle collision. Death was due to a bleeding Dieulafoy lesion of the stomach with a background of cardiomegaly. Dieulafoy lesion of the stomach is a rare disorder accounting for only 1-2% of cases of acute gastrointestinal hemorrhage. Although its pathogenesis is poorly understood it is capable of producing life-threatening bleeding, as in the present case. The small size of the lesion may make it difficult to identify at the time of autopsy.
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Affiliation(s)
- Luzern Tan
- Adelaide Medical School, The University of Adelaide, Frome Road, Level 2, Room N237, Helen Mayo North, Adelaide, SA, 5005, Australia
| | - John D Gilbert
- Forensic Science South Australia, 21 Divett Place, Adelaide, South Australia, 5005, Australia
| | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Frome Road, Level 2, Room N237, Helen Mayo North, Adelaide, SA, 5005, Australia.
- Forensic Science South Australia, 21 Divett Place, Adelaide, South Australia, 5005, Australia.
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Yano YI, Iguchi T, Sato S, Iseda N, Sasaki S, Abe Y, Nakayama T, Honboh T, Kato S, Sadanaga N, Matsuura H. Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report. Surg Case Rep 2023; 9:46. [PMID: 36961559 PMCID: PMC10039168 DOI: 10.1186/s40792-023-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Patients on long-term dialysis are prone to hemorrhagic complications, particularly uremic bleeding, but gallbladder hemorrhage is rare, even in patients on dialysis. There have been occasional reports of a Dieulafoy lesion being a cause of gastrointestinal hemorrhage, but its occurrence within the gallbladder is quite rare. This report describes a case of gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis that was diagnosed early and successfully treated by laparoscopic cholecystectomy. CASE PRESENTATION The patient was a 68-year-old woman on long-term hemodialysis with end-stage renal failure who presented with epigastralgia and back pain. There was no history of trauma or oral administration of antiplatelet or anticoagulant agents. There were no signs of an inflammatory reaction or hyperbilirubinemia. Contrast-enhanced computed tomography revealed a slightly hyperdense area in the distended gallbladder and extravasation within the gallbladder lumen but no gallstones. A severe atherosclerotic lesion was also found. She was diagnosed to have gallbladder hemorrhage and emergency laparoscopic cholecystectomy was performed. Although the postoperative course was complicated by drug fever, she was discharged on postoperative day 10 in a satisfactory condition. Histology revealed hemorrhagic ulceration with an exposed blood vessel accompanied by abnormal arteries in the submucosa. Arteriosclerosis with eccentric intimal hyperplasia in a small-sized artery was also seen. The diagnosis was gallbladder hemorrhage from a Dieulafoy lesion. CONCLUSIONS A Dieulafoy lesion should be kept in mind as a cause of gallbladder hemorrhage in a patient with severe arteriosclerosis and a bleeding diathesis, particularly if on dialysis, and treated as early as possible.
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Affiliation(s)
- Yuu-Ichi Yano
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Tomohiro Iguchi
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan.
| | - Shota Sato
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Norifumi Iseda
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Shun Sasaki
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Yasuhiro Abe
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Tomohiro Nakayama
- Department of Radiology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Takuya Honboh
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin Chuo-Ku, Fukuoka, Japan
| | - Noriaki Sadanaga
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Hiroshi Matsuura
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
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Masuda H, Gill AJ, Samra JS. A Rare Cause of Hemoperitoneum. Gastroenterology 2022; 163:e8-e10. [PMID: 35248540 DOI: 10.1053/j.gastro.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Hiro Masuda
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - Anthony J Gill
- Northern Clinical School, University of Sydney, Sydney, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
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Dieulafoy lesion of the gallbladder: A rare cause of hemobilia and acute pancreatitis - Case report. Int J Surg Case Rep 2019; 66:207-210. [PMID: 31865234 PMCID: PMC6931120 DOI: 10.1016/j.ijscr.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022] Open
Abstract
Dieulafoy lesion of the gallbladder is a very rare cause of hemobilia. Hemobilia should be considered as a cause of acute pancreatitis. Intraoperative cholangiogram is effective in flushing small biliary clots.
Introduction Dieulafoy lesion of the gallbladder is very rare. It can cause hemobilia and, consequently, acute pancreatitis. After extensive research, the authors found six reported cases of this entity, none of them presenting as acute pancreatitis. Case presentation A 78-year-old woman presented to the emergency department a right upper-quadrant pain and nausea. Abdominal ultrasound showed a gallbladder full of a heterogenic content with no signs of lithiasis or acute cholecystitis. Blood lipase was significantly elevated. She was admitted for acute pancreatitis. During hospitalization she developed jaundice and hematemesis requiring blood transfusion. The upper gastrointestinal (GI) endoscopy with side-view duodenoscopy showed blood through the papilla of Vater. Computed tomography and magnetic resonance imaging confirmed the content of the gallbladder with no changes in the biliary tree. A laparoscopic cholecystectomy with intraoperative cholangiogram was performed. Histology revealed a Dieulafoy lesion. The patient was discharged three days after surgery and had no subsequent episodes. Conclusion Hemobilia should be considered as a cause of upper GI bleeding and acute pancreatitis, especially if both are concurrent. Treatment is directed to the cause, with bleeding control and restoration of bile flow, which can be accomplished by a single minimally invasive surgery.
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Then EO, Bijjam R, Ofosu A, Rawla P, Culliford A, Gaduputi V. Rectal Dieulafoy's Lesion: A Rare Etiology of Lower Gastrointestinal Hemorrhage. Case Rep Gastroenterol 2019; 13:73-77. [PMID: 31043932 PMCID: PMC6477460 DOI: 10.1159/000497139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Abstract
A Dieulafoy's lesion is defined as a dilated submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion. It is a rare cause of gastrointestinal bleeding that is difficult to identify and subsequently manage. Most commonly, they occur in the upper gastrointestinal tract, namely the stomach. A Dieulafoy's lesion of the rectum, however, is an exceedingly rare presentation that can lead to life-threatening gastrointestinal bleeding. Our case consists of an 84-year-old man, who presented with lower gastrointestinal bleeding secondary to a Dieulafoy's lesion of the rectum.
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Affiliation(s)
- Eric Omar Then
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, New York, USA
| | - Rani Bijjam
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, New York, USA
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, USA
| | - Prashanth Rawla
- Department of Internal Medicine, Memorial Hospital of Martinsville and Henry County, Martinsville, Virginia, USA
| | - Andrea Culliford
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, New York, USA
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, New York, USA
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