Pérez Machado L, Arcos de González B
Policlínica Santiago de León, Caracas, Venezuela.
G E N. 1990 Jan-Mar;44(1):59-62.
Dieulafoy's lesion also known as exulceration simplex with submucosal arterial malformation is a rare cause of massive upper gastrointestinal hemorrhage with high mortality. Surgery that has been considered as the preferred diagnostic and therapeutic option has been supplemented by endoscopy; gastroscopy may be a valid alternative for diagnosis and therapy. Between 1981 and 1988 we report 4 cases with massive upper gastrointestinal hemorrhage, haematemesis and hemodynamic decompensation consistent with Dieulafoy's lesion. In all patients emergency gastroscopy was performed, monopolar electrocoagulation was successfully applied in two patients. One patient died during surgery and another sixteen days after surgery from multiple organ failure. Rebleeding was seen in one of the coagulated patients, the site of bleeding was identified as Dieulafoy's lesion in three patients during the first endoscopy and was arterial spurting with normal surrounding gastric mucosa. All lesions were found in the upper third of the stomach. Diagnosis is not easy, especially when the bleeding is intermittent but once identified, endoscopic treatment should be attempted and if this fails surgery may be promptly performed with possible lowering of mortality.
Dieulafoy病也称为伴有黏膜下动脉畸形的单纯性溃疡，是导致大量上消化道出血且死亡率高的罕见病因。曾被视为首选诊断和治疗方法的外科手术，如今已在内镜检查的辅助下进行；胃镜检查可能是诊断和治疗的有效替代方法。在1981年至1988年期间，我们报告了4例伴有大量上消化道出血、呕血和血流动力学失代偿且符合Dieulafoy病的病例。所有患者均接受了急诊胃镜检查，其中2例患者成功进行了单极电凝治疗。1例患者在手术期间死亡，另1例在术后16天死于多器官功能衰竭。1例接受电凝治疗的患者出现再出血，3例患者在首次内镜检查时出血部位被确定为Dieulafoy病，表现为动脉喷射出血且周围胃黏膜正常。所有病变均位于胃的上三分之一处。诊断并不容易，尤其是在出血呈间歇性时，但一旦确诊，应尝试内镜治疗，若治疗失败，可立即进行手术，这可能会降低死亡率。
