Alshumrani Ghazi, Almuaikeel Mohammed
Department of Radiology, King Khalid University, Abha, and the Department of Radiology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Diagn Interv Radiol. 2006 Sep;12(3):151-4.
Dieulafoy disease is an unusual cause of gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery commonly located in the proximal stomach. Since this disease first described in 1884, it has been rarely discussed in radiology literature. We describe a case of an elderly patient with multiple medical problems presented with upper and lower GI hemorrhage. Repeated upper GI endoscopies revealed a large fundal clot but otherwise were unremarkable. Angiography showed anomalous short gastric artery originating normally from the splenic artery. The latter was embolized with microcoils and Gelfoam. Following embolization, the frequency and amount of bleeding decreased although did not totally stop and the patient underwent elective partial gastrectomy. The diagnosis was made histologically. Therefore, Dieulafoy disease can represent a diagnostic and therapeutic challenge. It should be suspected if a patient with GI hemorrhage is found to have extravasation from a dilated tortuous artery that appears normal otherwise with no associated large draining veins. Transcatheter selective arterial embolization has a reported role in the literature as a less invasive therapeutic option compared to surgery.
迪厄拉富瓦病是一种可致命的不常见的胃肠道出血病因。它源于通常位于胃近端的异常粗大的糜烂黏膜下动脉。自1884年首次描述这种疾病以来，放射学文献中很少对其进行讨论。我们描述了一例患有多种内科疾病的老年患者，出现上、下消化道出血。多次上消化道内镜检查发现胃底有一大血块，但其他方面无异常。血管造影显示一条异常的胃短动脉正常起源于脾动脉。用微线圈和明胶海绵对脾动脉进行了栓塞。栓塞后，出血频率和出血量减少，尽管并未完全停止，患者接受了择期部分胃切除术。诊断通过组织学检查确定。因此，迪厄拉富瓦病可能是一个诊断和治疗难题。如果发现胃肠道出血患者有来自一条扩张迂曲但其他方面看似正常且无相关粗大引流静脉的动脉的造影剂外渗，就应怀疑该病。与手术相比，经导管选择性动脉栓塞在文献中被报道为一种侵入性较小的治疗选择。
