Novitsky Yuri W, Kercher Kent W, Czerniach Donald R, Litwin Demetrius E M
Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
J Gastrointest Surg. 2003 Jul-Aug;7(5):652-61. doi: 10.1016/s1091-255x(02)00435-3.
Watermelon Stomach (WS) has been increasingly recognized as an important cause of occult gastrointestinal blood loss. Clinically, patients develop significant iron deficiency anemia and are frequently transfusion dependent. The histologic hallmark of WS is superficial fibromuscular hyperplasia of gastric antral mucosa with capillary ectasia and microvascular thrombosis in the lamina propria. Endoscopic findings of the longitudinal antral folds containing visible columns of tortuous red ectatic vessels (watermelon stripes) are pathognomonic for WS. Trauma to the mucosal epithelium overlying engorged vessels by gastric acid or intraluminal food results in bleeding. Treatment options for WS include endoscopic, pharmacologic, and surgical approaches. Endoscopic therapy, including contact and non-contact thermal ablations of the angiodysplastic lesions, is the mainstay of conservative therapy. However, many patients fail endoscopic therapy and develop recurrent acute and chronic GI bleeding episodes. Surgical resection may be the only reliable method for achieving a cure and eliminating transfusion dependency. Traditionally, surgery was used only as a last resort after patients failed prolonged medical and/or endoscopic therapy. However, based on the experience garnered from the literature we recommend a more aggressive surgical approach in patients who fail a short trial of endoluminal therapy.
西瓜胃（WS）已日益被认为是隐匿性胃肠道失血的一个重要原因。临床上，患者会出现严重的缺铁性贫血，且常常依赖输血。WS的组织学特征是胃窦黏膜浅层纤维肌增生，固有层有毛细血管扩张和微血管血栓形成。内镜检查发现胃窦纵向皱襞内有可见的迂曲红色扩张血管柱（西瓜条纹）是WS的特征性表现。胃酸或腔内食物对充血血管上方的黏膜上皮造成损伤会导致出血。WS的治疗选择包括内镜治疗、药物治疗和手术治疗。内镜治疗，包括对血管发育异常病变进行接触性和非接触性热消融，是保守治疗的主要手段。然而，许多患者内镜治疗失败，出现反复的急性和慢性胃肠道出血发作。手术切除可能是实现治愈和消除输血依赖的唯一可靠方法。传统上，手术仅在患者经过长期药物和/或内镜治疗失败后才作为最后手段使用。然而，根据从文献中获得的经验，我们建议对腔内治疗短期试验失败的患者采用更积极的手术方法。
