Dieulafoy lesion of the appendix

Abstract

ttp://dx.doi.org/10.1016/j.dld.2014.04.001 590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All dicitis (Fig. S1, asterisk), the mid and distal appendiceal wall was modified by the presence of a large (2 mm) calibre thick-walled submucosal artery about 10 mm long, corresponding to a Dieulafoy lesion. This calibre-persistent artery originated from the mesoappendix and entered the appendiceal wall directly without previous subdivision (Figs. 1 and S1, arrow). The overlying mucosa at a distance from the inflammatory lesions was intact (Fig. 1, arrowhead) and no previous history of gastrointestinal bleeding was reported, suggesting an incidental non-complicated lesion. Only one similar case associated with lower gastrointestinal bleeding and cured with simple appendectomy has been reported by Japanese authors [1]. Dieulafoy lesion is an uncommon vascular malformation of the gastrointestinal tract characterized by the presence of a thickwalled submucosal artery in an otherwise normal intestinal wall. It can be a cause of massive gastrointestinal bleeding through a small mucosal erosion known as Dieulafoy’s ulcer. It predominates in the stomach but may also exceptionally involve the small bowel, colon and rectum. These cases of appendiceal localizations of a Dieulafoy lesion confirm that this vascular malformation may involve all parts of the gastrointestinal tract and that this peculiar localization may be a diagnostic challenge in cases of massive gastrointestinal tract bleeding. Supplementary material related to this article can be found, in the online version, at http://dx.doi.org/10.1016/j.dld.2014.04.001.