Department of Gastroenterology, Dokkyo Medical University, 880, Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
Clin J Gastroenterol. 2021 Feb;14(1):71-75. doi: 10.1007/s12328-020-01257-7. Epub 2020 Oct 6.
Most cases of Dieulafoy's lesion, a rare cause of upper gastrointestinal bleeding, occur in the upper gastric corpus, usually with no edematous bulging or fold convergence around the mucosal defect. This report describes a case of Dieulafoy's lesion with subepithelial lesion (SEL)-like morphology. Endoscopic treatment by hemoclipping was difficult. Because of repeated bleeding, abdominal dynamic contrast computed tomography (CT) was conducted. Results showed a large caliber, tortuous artery branching directly from the celiac artery and feeding into the gastric wall of the gastric fundus. Rupture of this vessel in the submucosa was thought to be responsible for the SEL-like morphology. All findings indicated endoscopic treatment from the gastric mucosal side was too difficult. Therefore, we treated the lesion using interventional radiology (IR) technique of vascular embolization. If an SEL-like Dieulafoy's lesion cannot be treated by endoscopic hemostasis, then IR might be necessary to treat the vascular anomaly.
大多数情况下，迪厄拉富瓦病（Dieulafoy's lesion）是一种罕见的上消化道出血原因，发生在上胃体，通常在黏膜缺损周围没有水肿性隆起或褶皱聚集。本报告描述了一例具有黏膜下病变（SEL）样形态的迪厄拉富瓦病。内镜下夹闭治疗困难。由于反复出血，进行了腹部动态对比 CT（CT）检查。结果显示，从腹腔动脉直接分支并进入胃底胃壁的大口径、迂曲动脉，认为该血管在黏膜下破裂导致了 SEL 样形态。所有发现均表明，从胃黏膜侧进行内镜治疗非常困难。因此，我们使用介入放射学（IR）的血管栓塞技术治疗该病变。如果无法通过内镜止血治疗 SEL 样迪厄拉富瓦病，则可能需要 IR 治疗血管畸形。
