Kovács Márta, Pák Péter, Pák Gábor, Fehér János, Hüttl Kálmán
Vaszary Kolos Kórház II. Belgyógyászati Osztály Esztergom Petofi u. 26-28. 2500.
Orv Hetil. 2007 Dec 23;148(51):2435-40. doi: 10.1556/OH.2007.28272.
Angiodysplasias are the most frequent vascular lesions of the gastrointestinal tract and sources of significant mortality from bleeding. Small bowel angiodysplasias account for approximately 40% of cases of gastrointestinal bleeding with obscure origin and represent the single most common cause for hemorrhage in this subset of patients. Their cause is unknown but most are probably acquired and the result of a degenerative process associated with aging. The difficulty of their diagnosis stems from their multiple appearance and small size. Examinations that have been performed so far support that the sensitivity of capsule endoscopy (CE) performed during active bleeding was higher than in case of previous overt bleeding and occult bleeding.
A 61-year-old female patient, who has received anticoagulant therapy for 13 years, presented with recurrent gastrointestinal bleeding of obscure origin underwent wireless capsule endoscopy after negative upper endoscopy and colonoscopy. CE showed non-bleeding typical angiodysplasia in the antrum of the stomach and active bleeding in the first third of jejunum without a visible bleeding source. As the next diagnostic step we performed selective mesenteric angiography to clarify the diagnosis and at the same time we also applied radiological intervention.
Capsule endoscopy changed in practice guidelines for obscure bleeding and became the first-line method for evaluation of patient after upper endoscopy and colonoscopy have been shown to be negative. If the examination is performed early, CE could shorten considerably the time to diagnosis, lead to definitive treatment and numerous examinations with low yield could be avoided. The therapy of small bowel angiodysplasias is questionable. Radiological intervention poses the least load for the patient.
血管发育异常是胃肠道最常见的血管病变，也是出血导致严重死亡的原因。小肠血管发育异常约占不明原因胃肠道出血病例的40%，是这类患者出血的最常见单一原因。其病因不明，但大多数可能是后天获得的，是与衰老相关的退行性过程的结果。其诊断困难源于其多样的表现和较小的尺寸。迄今为止进行的检查表明，在活动性出血期间进行的胶囊内镜检查（CE）的敏感性高于既往显性出血和隐匿性出血的情况。
一名61岁女性患者，接受抗凝治疗13年，出现不明原因的反复胃肠道出血，在上消化道内镜检查和结肠镜检查阴性后接受了无线胶囊内镜检查。CE显示胃窦部有非出血性典型血管发育异常，空肠上段有活动性出血但无可见出血源。作为下一步诊断措施，我们进行了选择性肠系膜血管造影以明确诊断，同时也实施了放射介入治疗。
胶囊内镜改变了不明原因出血的实践指南，在上消化道内镜检查和结肠镜检查均显示阴性后，成为评估患者的一线方法。如果早期进行检查，CE可显著缩短诊断时间，实现确定性治疗，并避免大量低收益的检查。小肠血管发育异常的治疗存在疑问。放射介入对患者的负担最小。
