Bisogni D, Valeri A, Talamucci L, Manetti R, Giordano A B F, Ardu M, Naspetti R, Prosperi P
G Chir. 2019 Sep-Oct;40(5):398-404.
Hiatal hernias (HHs) are usually divided into two main groups: sliding and para-esophageal (torsional) ones. Sometimes patients presenting HHs experience progressive anemia, whereas rarely an acute anemia with melena or hematemesis can occur. In such cases a Cameron ulcer should be suspected and a careful esophago-gastro-duodenoscopy (EGDS) with a meticulous inspection of the mucosal folds along the neck of the hernia is the best examination in order to find out the ulcer itself. In front of massive hemorrhage due to a Cameron erosion, the first aim should be the control of the bleeding itself, in order to ree1Romastablish hemodynamic stability. The Authors report the case of a 72-year-old man presenting a severe bleeding secondary to a large Cameron ulcer in a para-esophageal hiatal hernia. Firstly, a combined medical-endoscopic therapy was tried; the patient underwent transfusions of pooled red blood cells and endovenous anti-acid therapy combined with an operative endoscopic treatment; unfortunately this initial approach failed, therefore the patient was referred to surgery. The surgeons realized a minimally invasive atypical gastric resection associated with the HH repair; the post-operative course was uneventful and no other rebleeding episodes occurred. The urgency treatment of a life-threatening bleeding for Cameron ulcers remains a very challenging problem as no univocal and standardized recommendation has been described in literature since now. In this case-report the Authors make an overview of the current literature on the treatment of Cameron ulcers, describing a novel surgical technique for massive upper gastro-intestinal bleeding secondary to these lesions.
食管裂孔疝（HHs）通常分为两大类：滑动型和食管旁（扭转型）。有时患有食管裂孔疝的患者会出现进行性贫血，而伴有黑便或呕血的急性贫血则很少见。在这种情况下，应怀疑存在卡梅伦溃疡，仔细的食管-胃-十二指肠镜检查（EGDS）并对疝颈部的黏膜皱襞进行细致检查是发现溃疡本身的最佳检查方法。面对因卡梅伦糜烂导致的大量出血，首要目标应是控制出血本身，以恢复血流动力学稳定。作者报告了一例72岁男性患者，因食管旁裂孔疝中的大卡梅伦溃疡继发严重出血。首先尝试了联合药物-内镜治疗；患者接受了浓缩红细胞输血、静脉抗酸治疗并结合内镜手术治疗；不幸的是，这种初始方法失败了，因此患者被转诊至外科。外科医生实施了与食管裂孔疝修复相关的微创非典型胃切除术；术后过程顺利，未再发生其他出血事件。对于卡梅伦溃疡危及生命的出血进行紧急治疗仍然是一个极具挑战性的问题，因为目前文献中尚未描述明确且标准化的建议。在本病例报告中，作者对当前关于卡梅伦溃疡治疗的文献进行了综述，描述了一种针对这些病变继发的大量上消化道出血的新型手术技术。
