Si Chen, Xiuli Zhu, Li Xie, Yong Jia, Ying Zhou, Kaiguang Zhang
Department of Gastroenterology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
Department of Obstetrics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
BMC Gastroenterol. 2017 Jul 31;17(1):89. doi: 10.1186/s12876-017-0646-1.
Dieulafoy's lesion (DL) is one of the rare causes of upper gastrointestional bleeding. This disease is characterized by small sub-mucosal arteriole that eroded the stomach mucosa and cause severe upper GI bleeding without obvious ulceration. The most common location is fundus area of stomach and usually affects patients over 50 years of age with multiple comorbidities.
We report a case of life-threatening bleeding from DL during late pregnancy 31 weeks. Hemoclips were used twice through upper endoscopy with successful hemostasis. Unfortunately, she developed HELLP syndrome diagnosed 5 days after the GI bleeding was stopped. Her pregnancy had to be terminated with delivery of a premature infant. She recovered from her illness and discharged from hospital uneventfully. There is no current report in literature of DL in pregnant woman subsequently suffered HELLP syndrome.
Endoscopic hemoclip application is an effective technique in the treatment of upper GI bleeding from DL. For this patient, laparoscopic surgery or combination therapy before pregnancy may have been a suitable treatment on preventing rebleeding.
Dieulafoy病（DL）是上消化道出血的罕见原因之一。该病的特征是小的粘膜下小动脉侵蚀胃粘膜并导致严重的上消化道出血，且无明显溃疡。最常见的部位是胃底部，通常影响50岁以上患有多种合并症的患者。
我们报告一例在妊娠31周晚期发生的危及生命的DL出血病例。通过上消化道内镜检查使用了两次止血夹，成功止血。不幸的是，在消化道出血停止5天后，她被诊断出患有HELLP综合征。她的妊娠不得不终止，并分娩了一名早产儿。她康复后顺利出院。目前文献中尚无关于DL孕妇随后发生HELLP综合征的报道。
内镜下应用止血夹是治疗DL所致上消化道出血的有效技术。对于该患者，妊娠前行腹腔镜手术或联合治疗可能是预防再出血的合适治疗方法。
