A 60-year-old man presents with massive painless hematemesis. Endoscopy shows a small, solitary mucosal defect less than 3 mm on the proximal gastric lesser curvature with arterial spurting, but no surrounding ulceration or mass. Biopsy is normal apart from the exposed vessel. What is the underlying lesion?

• A Gastric antral vascular ectasia
• B Mallory-Weiss tear
• C Caliber-persistent artery of the colon
• D Dieulafoy lesion ✓

Explanation

D Dieulafoy lesion is an abnormally large caliber-persistent submucosal artery that erodes through a tiny overlying mucosal defect, classically within 6 cm of the gastroesophageal junction along the lesser curve. It causes massive recurrent bleeding with minimal or no visible mucosal abnormality, and treatment is endoscopic hemostasis. Mallory-Weiss tears follow retching and appear as longitudinal mucosal fissures at the GEJ. GAVE produces diffuse antral erythema, not focal spurting.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.