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Abstract L’ulcère de Dieulafoy est une cause rare d’hémorragie digestive massive pouvantêtre fatale. Le saignement se produit à partir d’une anomalie vasculaire définiepar la présence dans la sous- muqueuse, d’une artère aberrante anormalementlarge. La localisation gastrique est la plus fréquemment rapportée mais de rarescas ont été confirmés à l’examen anatomopathologique.Nous rapportons l’observation d’un homme de 32 ans opéré en urgence pour unehémorragie digestive haute massive, menaçant le pronostic vital et ne permettantpas de localiser la lésion à l’examen endoscopique. Un ulcère de Dieulafoygastrique a été diagnostiqué en per opératoire, traité par wedge résection etconfirmé à l’examen histopathologique. Abstract Dieulafoy’s lesion is a rare cause of massive digestive hemorrhage that can be fatal. Bleeding occurs from a vascular abnormality defined by the presence in the submucosa of an abnormally large aberrant artery. Gastric localization is the most frequently reported, but rare cases have been confirmed by histology.We report the case of a 32-year-old man operated on an emergency for massive upper gastrointestinal haemorrhage, which is life threatening and not allowing to locate the lesion with the endoscopic examination. A Dieulafoy’s gastric lesion was diagnosed intraoperatively, treated by wide wedge resection and confirmed by histology.

Abstract Background Dieulafoy’s disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This paper reports a case of bronchial Dieulafoy’s disease and summarizes the data of similar cases reported in literature. Methods We report a case of bronchial Dieulafoy’s disease (BDD) in Tunisia. We also present a review of literature related to BDD from 1995 to 2022 using the PubMed, Google Scholar, web of science and Chinese National Knowledge Infrastructure Databases. Clinical characteristics, chest imaging, bronchoscopic and angiographic findings were summarized. Treatment courses were identified as well as patients’ outcome. Results We report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy’s disease of the bronchus. Ninety cases of BDD were reported from 1995 to 2022. The main symptom was hemoptysis. Chest imaging findings were not specific. The diagnosis of BDD was mainly based on the bronchoscopy, branchial angiography and pathological findings or surgical specimens. Bronchoscopy findings were mostly nodular or prominent lesions (52.4%). Twenty-eight patients underwent bronchoscopic biopsies, 20 had massive bleeding and 10 died. Bronchial angiography mainly showed tortuous and dilation of bronchial artery, and the lesions were mainly located in the right bronchus. Selective bronchial artery embolization (SBAE) was performed in 32 patients and 39 patients underwent surgery. Conclusion To our knowledge, this is the first case of bronchial Dieulafoy’s disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopic biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required.

Background: Dieulafoy's disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world. This paper reports a case of bronchial Dieulafoy's disease and summarizes the data of similar cases reported in literature. Methods: We report a case of bronchial Dieulafoy's disease (BDD) in Tunisia. We also present a review of literature related to BDD from 1995 to 2022 using the PubMed, Google Scholar, web of science and Chinese National Knowledge Infrastructure Databases. Clinical characteristics, chest imaging, bronchoscopic and angiographic findings were summarized. Treatment courses were identified as well as patients' outcome. Results: We report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy's disease of the bronchus. Ninety cases of BDD were reported from 1995 to 2022. The main symptom was hemoptysis. Chest imaging findings were not specific. The diagnosis of BDD was mainly based on the bronchoscopy, branchial angiography and pathological findings or surgical specimens. Bronchoscopy findings were mostly nodular or prominent lesions (52.4%). Twenty-eight patients underwent bronchoscopic biopsies, 20 had massive bleeding and 10 died. Bronchial angiography mainly showed tortuous and dilation of bronchial artery, and the lesions were mainly located in the right bronchus. Selective bronchial artery embolization (SBAE) was performed in 32 patients and 39 patients underwent surgery. Conclusion: To our knowledge, this is the first case of bronchial Dieulafoy's disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopic biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required. [ABSTRACT FROM AUTHOR]

Dieulafoy's disease is a rare and important cause of recurrent upper gastrointestinal bleeding, which can cause fatal gastrointestinal bleeding. We reported a patient with Dieulafoy's disease in both of the stomach and duodenum for the first time. The patient achieved no effective hemostasis after two endoscopic treatments and two arterial angiography embolizations. Finally, successful hemostasis was achieved through surgery. There are many endoscopic treatment methods, but there is no consensus on the best treatment for hemorrhagic Dieulafoy's disease. Surgery is only a last resort after the failure of endoscopic treatment and angiography embolization. [ABSTRACT FROM AUTHOR]

Dieulafoy’s lesion is a rare cause of massive digestive hemorrhage that can be fatal. Bleeding occurs from a vascular abnormality defined by the presence in the submucosa of an abnormally large aberrant artery. Gastric localization is the most frequently reported, but rare cases have been confirmed by histology.We report the case of a 32-year-old man operated on an emergency for massive upper gastrointestinal haemorrhage, which is life threatening and not allowing to locate the lesion with the endoscopic examination. A Dieulafoy’s gastric lesion was diagnosed intraoperatively, treated by wide wedge resection and confirmed by histology.

Although there are many clinical reports on Dieulafoy's disease, there are few studies on the pathological structure of vascular wall in Dieulafoy's disease. In this study, the main structural changes of the intima and media of the vascular wall were observed by special staining and immunohistochemical methods in the subjects of Dieulafoy's disease of stomach and intestine. There were many vessels of different sizes in the submucosa, with uneven wall thickness of the vessels. Compared with the normal control group, the content of blue collagen fibers between the vascular smooth muscle cells in the lesion group was increased, the elastic fibers were thickened, and the internal elastic plate was arranged stiff or even interrupted. The increase of collagen and elastic fibers between the smooth muscle cells of the medium membrane and the destruction of the structure of the inner elastic plate may be the structural basis of vascular lesions leading to Dieulafoy's disease. [ABSTRACT FROM AUTHOR]