Li Da-Huan, Liu Xue-Ying, Xu Liang-Bi
Center of Digestive Endoscopy, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China.
Department of Gastroenterology, Guizhou Medical University, Guiyang 550000, Guizhou Province, China.
World J Clin Cases. 2020 Dec 6;8(23):6009-6015. doi: 10.12998/wjcc.v8.i23.6009.
Gastrointestinal stromal tumors (GISTs) are mesenchymal tissue tumors originating from Cajal cells, presenting diverse clinical manifestations due to the different sizes, locations, and growth patterns of the lesions. Duodenum is an uncommon site of GISTs, more with gastrointestinal obstruction and bleeding as the first symptoms. Ectopic duodenal varix, as a rare varix occurring outside the gastroesophageal region, is the main type of heterotopic varices and an unusual cause of gas-trointestinal hemorrhage. The etiology is mainly seen in liver cirrhosis, portal hypertension, vasculitis, portal vein embolism and obstruction caused by various factors. Reports of duodenal stromal tumor combined with ectopic variceal hemorrhage are rarely seen; however, when it occurs, the situation can sometimes be urgent and life-threatening, especially when traditional endoscopy and imaging fail to detect the lesion timely.
We report a 52-year-old female patient who had no obvious inducement to develop black stool. Gastroscopy in a local hospital revealed that the duodenal horizontal ectopic varices were ruptured and bleeding. After metal clamping hemostasis, she still had gastrointestinal bleeding and was transferred to our hospital. Gastroscopy showed that active bleeding was still seen in the horizontal part of duodenum, and suspicious submucosal eminence was seen in the bleeding part. Abdominal computed tomography showed a huge stromal tumor of duodenum, specimens were pathologically confirmed after surgery. After a 3-mo follow-up, no gastrointestinal hemorrhage and complications occurred.
Ectopic variceal hemorrhage is rare but sometimes fatal. It may be combined with stromal tumor, which can be diagnosed by multiple methods. Endoscopic and surgical treatment are effective.
胃肠道间质瘤（GIST）是起源于 Cajal 细胞的间叶组织肿瘤，由于病变的大小、位置和生长方式不同而呈现出多样的临床表现。十二指肠是 GIST 的少见发病部位，多以胃肠道梗阻和出血为首发症状。十二指肠异位静脉曲张作为一种发生在胃食管区域以外的罕见静脉曲张，是异位静脉曲张的主要类型，也是胃肠道出血的少见原因。其病因主要见于肝硬化、门静脉高压、血管炎、门静脉栓塞以及各种因素导致的门静脉梗阻。十二指肠间质瘤合并异位静脉曲张出血的报道少见；然而，一旦发生，病情有时可能紧急且危及生命，尤其是当传统内镜检查和影像学检查未能及时发现病变时。
我们报告一名 52 岁女性患者，无明显诱因出现黑便。当地医院胃镜检查显示十二指肠水平部异位静脉曲张破裂出血。金属夹止血后仍有胃肠道出血，遂转至我院。胃镜检查显示十二指肠水平部仍有活动性出血，出血部位可见可疑黏膜下隆起。腹部计算机断层扫描显示十二指肠巨大间质瘤，术后病理标本确诊。随访 3 个月后，未发生胃肠道出血及并发症。
异位静脉曲张出血少见但有时可致命。它可能合并间质瘤，可通过多种方法诊断。内镜和手术治疗有效。
