Vetto J T, Richman P S, Kariger K, Passaro E
Department of General Surgery, UCLA Medical Center.
Arch Surg. 1989 Dec;124(12):1460-2. doi: 10.1001/archsurg.1989.01410120110021.
Cirsoid aneurysms (exulceratio simplex Dieulafoy) as a cause of massive gastrointestinal hemorrhage have been known to occur in the stomach. Endoscopy plays an important role in the diagnosis of and therapy for these lesions. We report two cases of a cirsoid aneurysm in the proximal jejunum; two cases have been previously reported in the literature. These lesions have the same pathologic features as gastric cirsoid lesions and cause massive gastrointestinal hemorrhage. Because these lesions are beyond the reach of current endoscopy, surgery was necessary to diagnose and treat the lesions in three of four patients. The fourth patient died after unsuccessful surgical exploration, and the lesion was found post mortem. Jejunal cirsoid aneurysms may be an unrecognized rather than a rare cause of gastrointestinal bleeding. They should be considered in the patient with massive proximal gastrointestinal bleeding in whom the source is not known, especially if angiography suggests a small-bowel site. With the advent of newer forms of endoscopy that can examine the small bowel, the management of these lesions may change; at present, surgery is lifesaving.
蔓状动脉瘤（单纯性溃疡迪厄拉富瓦病）作为大量胃肠道出血的一个原因，已知可发生于胃。内镜检查在这些病变的诊断和治疗中起着重要作用。我们报告两例发生于空肠近端的蔓状动脉瘤；此前文献中已有两例报道。这些病变具有与胃蔓状病变相同的病理特征，并可导致大量胃肠道出血。由于这些病变超出了目前内镜检查的范围，四例患者中有三例需要手术来诊断和治疗病变。第四例患者手术探查失败后死亡，病变在尸检时发现。空肠蔓状动脉瘤可能是胃肠道出血一个未被认识而非罕见的原因。对于大量近端胃肠道出血且出血源不明的患者应考虑到该病，尤其是血管造影提示小肠部位时。随着能够检查小肠的新型内镜的出现，这些病变的治疗可能会改变；目前，手术是挽救生命的方法。
