Fujikawa Takahisa, Maekawa Hisatsugu, Shiraishi Kei, Tanaka Akira
Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
BMJ Case Rep. 2012 Sep 24;2012:bcr2012006779. doi: 10.1136/bcr-2012-006779.
We report a case of a 57-year-old man who started dual-antiplatelet therapy with aspirin and clopidogrel following implantation of drug-eluting coronary stent and developed persistent active gastrointestinal bleeding. After detecting the origin of bleeding by double-balloon enteroscopy, successful laparoscopy-assisted partial jejunal resection was performed and the patient condition was promptly recovered, without any thrombotic or bleeding complications. Pathology revealed arteriovenous malformation of the jejunum without any malignancy. We should care for and be aware of this lesion as a rare cause of gastrointestinal bleeding when strong antithrombotic therapy is initiated. Under rigorous assessment and perioperative management, as well as meticulous intraoperative dissection and haemostasis, satisfactory outcome was achieved even in this complicated situation.
我们报告一例57岁男性患者，在植入药物洗脱冠状动脉支架后开始使用阿司匹林和氯吡格雷进行双联抗血小板治疗，并出现持续性活动性胃肠道出血。通过双气囊小肠镜检查发现出血源后，成功进行了腹腔镜辅助部分空肠切除术，患者病情迅速恢复，无任何血栓形成或出血并发症。病理显示空肠动静脉畸形，无任何恶性病变。当启动强化抗栓治疗时，我们应关注并意识到这种病变是胃肠道出血的罕见原因。在严格的评估和围手术期管理以及细致的术中解剖和止血操作下，即使在这种复杂情况下也取得了满意的结果。
