LDepartment of Internal Medicine, Division of Gastroenterology, Chonnam Medeical University Hwasun Hospital, Hwasun, Jeonnam, South Korea.
BMC Gastroenterol. 2010 Feb 23;10:24. doi: 10.1186/1471-230X-10-24.
Duodenal Dieulafoy's lesions are rare and only several cases were reported so far. Their characteristic appearance and location make it difficult to be diagnosed in the clinical practice. Massive bleeding often results from these lesions and can impede the accurate early treatment.
67 years old male patient suffered a fatal bleeding from Dieulafoy-like lesion located at the mouth of the periampullary diverticulum. Initial endoscopic therapy and radiologic embolization failed to stop the bleeding, while direct observation and hemoclipping by the side viewing endoscopy successfully established correct diagnosis and permanent cure of the lesion.
Aggressive endoscopic examinations combined with the accurate endoscopic treatment should be adopted when Dieulafoy-like lesion is suspected as a possible cause of the proximal small bowel hemorrhage. Verification of the diagnosis and definitive treatment often needed repeated examination by side-viewing endoscope as well as stabilization of the patient.
十二指肠 Dieulafoy 病变较为罕见，目前仅报道了少数几例。其特征性的外观和位置使得在临床实践中难以诊断。这些病变常导致大出血，且可能阻碍准确的早期治疗。
一名 67 岁男性患者因位于十二指肠乳头旁憩室口的 Dieulafoy 样病变发生致命性出血。最初的内镜治疗和放射介入栓塞未能止血，而通过侧视内镜直接观察和夹闭成功确立了病变的正确诊断和永久性治愈。
当疑似近端小肠出血的可能病因是 Dieulafoy 样病变时，应采用积极的内镜检查，并结合准确的内镜治疗。诊断的验证和明确的治疗通常需要通过侧视内镜反复检查以及患者的稳定情况。
