Franko E, Chardavoyne R, Wise L
Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York.
Am J Gastroenterol. 1991 Oct;86(10):1545-7.
Dieulafoy's ulcer is an uncommon lesion that usually presents with massive bleeding. Although it has been observed, for the most part, in the stomach, it has also been identified in the small bowel and colon. Both endoscopy and angiography have been used for diagnosis; however, endoscopy has had a high failure rate for localizing colonic disease during active bleeding. Treatment has been primarily surgical, but endoscopic coagulation and sclerotherapy have been recently employed. A 20-year-old male presented with massive lower gastrointestinal bleeding, which was found to be caused by a Dieulafoy's ulcer in the rectum. Observation of Dieulafoy's ulcer in the rectum has not been reported previously. Diagnosis was by rigid sigmoidoscopy. This lesion was treated by widely oversewing the vessel after endoscopic therapy failed. The etiology of this lesion is most likely congenital. Hemorrhage probably occurs as a result of mechanical damage of the mucosa, combined with erosion of the vessel by fecal flow. Unlike colonic Dieulafoy's ulcers, it should be possible to diagnose rectal lesions by rigid sigmoidoscopy. This diagnosis may be difficult with high rectal ulcers, and angiography may have to be employed. Endoscopic therapy failed here, as in other reports on colonic disease. Thus, we would recommend widely oversewing rectal lesions as the primary treatment. Resection should be reserved for cases that have failed this therapy.
迪厄拉富瓦溃疡是一种罕见的病变，通常表现为大量出血。虽然大部分情况下在胃中观察到，但在小肠和结肠中也有发现。内镜检查和血管造影都已用于诊断；然而，在内镜检查中，在活动性出血期间定位结肠疾病的失败率很高。治疗主要是手术治疗，但最近也采用了内镜下凝血和硬化疗法。一名20岁男性出现大量下消化道出血，发现是由直肠的迪厄拉富瓦溃疡引起的。此前尚未有直肠迪厄拉富瓦溃疡的报道。通过硬式乙状结肠镜检查进行诊断。在内镜治疗失败后，通过广泛缝合血管来治疗该病变。该病变的病因很可能是先天性的。出血可能是由于黏膜的机械损伤，再加上粪便流动对血管的侵蚀所致。与结肠迪厄拉富瓦溃疡不同，通过硬式乙状结肠镜检查应该能够诊断直肠病变。对于高位直肠溃疡，这种诊断可能困难，可能不得不采用血管造影。与其他关于结肠疾病的报道一样，这里的内镜治疗失败了。因此，我们建议将广泛缝合直肠病变作为主要治疗方法。对于这种治疗失败的病例，应保留切除术。
