Fatal exulceratio simplex (dieulafoy lesion) - a case report and review

Area of Science:

• Gastroenterology
• Pathology
• Forensic Medicine

Background:

• Dieulafoy lesions are a rare cause of acute gastrointestinal hemorrhage, accounting for 1-2% of cases.
• These lesions involve a submucosal arteriole that erodes into the gastric lumen, potentially causing massive bleeding.
• The pathogenesis of Dieulafoy lesions remains poorly understood.

Purpose of the Study:

• To present a case of fatal gastrointestinal bleeding caused by a Dieulafoy lesion.
• To highlight the diagnostic challenges associated with identifying small Dieulafoy lesions during autopsy.
• To underscore the potential severity of Dieulafoy lesions, even in the absence of trauma.

Main Methods:

• Autopsy examination of a 64-year-old male following a low-speed vehicle collision.
• Detailed gross and histological examination of the gastrointestinal tract.
• Correlation of autopsy findings with the cause of death.

Main Results:

• Autopsy revealed altered blood from the stomach to the rectum, indicating significant gastrointestinal bleeding.
• A Dieulafoy lesion, characterized by a tortuous arteriole in the submucosa opening into the gastric lumen, was identified.
• The cause of death was determined to be a bleeding Dieulafoy lesion, with cardiomegaly as a contributing factor; the vehicle collision was not implicated.

Conclusions:

• Dieulafoy lesions can cause life-threatening gastrointestinal hemorrhage.
• The small size and subtle nature of Dieulafoy lesions can make them difficult to detect during autopsy.
• This case emphasizes the importance of considering Dieulafoy lesions in unexplained gastrointestinal bleeding, even when other potential causes like trauma are present.