Dieulafoy's lesion or cirsoid
aneurysm is a rare cause of massive upper
gastrointestinal hemorrhage. Historically cirsoid
aneurysm most often occurs in the stomach, but has been reported to occur in the jejunum. In this paper, four cases are presented that are felt to represent the first documented cases of cirsoid
aneurysm involving the duodenum. At endoscopy, the appearance of Dieulafoy's lesion may range from a pinpoint dot, clot, or tortuous vessel, to blood oozing or spurting from normal mucosa. A shallow defect may be present that can give the appearance of a partially healed
peptic ulcer. Previous histologic studies have shown a wide-caliber-persistent artery with intimal thickening,
sclerosis, and medial muscular
hypertrophy. Once the diagnosis is made, surgical intervention utilizing simple
ligation of the involved vessel results in cessation of recurrent
hemorrhage. Dieulafoy's lesion is probably more common than the previous literature would suggest. The lesion needs to be considered in the clinical setting of the patient with massive upper
gastrointestinal hemorrhage, a paucity of symptoms, and negative findings on
barium studies, endoscopy, and exploratory
laparotomy.