背景:Dieulafoy病变(DL)是一种血管畸形,可导致消化道大出血。它通常在胃中发现。然而,在小肠和结肠等非典型部位发生DL异常罕见,带来了重大的管理挑战。
方法:在本报告中,我们介绍了两例发生在罕见部位的DL,每个人都用不同的方法管理。病例1是一名50岁的男子,由于大量胃肠道出血和血流动力学不稳定而进入急诊科。DL的诊断是通过计算机断层扫描血管造影建立的,并在急诊手术后经组织病理学检查证实。病例2涉及一名68岁的妇女,由于结肠DL而出现黑便。该病例通过内镜止血方法成功治疗。
结论:Dieulafoy的病变(DL)在PaulGeorgesDieulafoy的三例患者中首次被确定为缺乏典型胃溃疡特征的大粘膜下动脉。该病变约占所有胃肠道出血病例的1-2%。内窥镜检查是诊断和管理DL病变的首选方法。特别是在活动性出血的情况下。然而,如果内镜治疗或血管造影栓塞失败,可能需要手术方法。
结论:DL由于其稀有性而提出了诊断挑战,通常不包括在消化道出血的鉴别诊断中。特别是发生在不寻常的地方。内窥镜检查是确定DL的首选方法,也是活动性出血的可能治疗方法。然而,如果内镜止血失败,可能需要血管造影栓塞或手术干预.
BACKGROUND: Dieulafoy\'s lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It\'s usually found in the stomach. However, DL\'s occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management challenges.
METHODS: In this report, we present two cases of DL occurring in uncommon sites, each managed with distinct approaches.
Case 1 is a 50-year-old man admitted to the emergency department due to massive GI bleeding and hemodynamic instability. The diagnosis of DL was established through computed tomography angiography and confirmed by histopathological examination after emergency surgery.
Case 2 involves a 68-year-old woman presented with melena due to a colonic DL. This
case was successfully managed through an endoscopic hemostasis approach.
CONCLUSIONS: Dieulafoy\'s lesions (DL) were first identified as a large submucosal artery lacking typical gastric ulcer characteristics in three of Paul Georges Dieulafoy\'s patients. This lesion is responsible for approximately 1-2 % of all cases of gastrointestinal bleeding. Endoscopy is the preferred method for diagnosing and managing DL lesions, especially in cases of active bleeding that is accessible. However, if endoscopic treatment or angiographic embolization fails, a surgical approach may be needed.
CONCLUSIONS: DL presents a diagnostic challenge due to its rarity and is not usually included in the differential diagnosis of gastrointestinal bleeding, particularly when occurring in unusual sites. Endoscopy is the preferred method to identify DL and a possible therapeutic approach in active bleeding. However, if endoscopy hemostasis fails, angiographic embolization or surgical intervention may be required.