Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Medicine (Baltimore). 2022 Jun 24;101(25):e29474. doi: 10.1097/MD.0000000000029474.
Dieulafoy's lesion (DL) presented with small bowel bleeding constitutes a group of rare and potentially life-threatening prognosis. Several case series have described this condition, yet it remains unclear as to what is the optimal treatment and predicted outcome for patients who have been diagnosed.
We present a 21-year-old male experiencing bloody stool for 1 day.
Computed tomography of the abdomen exhibited active contrast extravasations and segmental wall thickening in the jejunum, and enteroscopy showed one 15-millimeter sized subepithelial tumor at the proximal jejunum.
Due to unstable vital signs he received an emergent transcatheter arterial embolization, and surgeon performed a laparoscopic surgical resection thereafter under the impression of potential malignancy. The pathologist confirmed jejunal DL with organizing thrombus.
He was discharged on the 8th day of hospitalization without recurrent bleeding.
A systematic literature review of 98 published cases taken from PubMed dating back to 1978 was undertaken, and the patients with DL and small bowel bleeding involved mainly the jejunum, followed by the duodenum and ileum. Meanwhile, DL-related duodenal bleeding was diagnosed mostly by an enteroscopy, as well as endoscopic interventions. Jejunal and ileal bleeding due to DL was surveyed through endoscopy and surgery, while surgical resection remained the choice for bleeding cessation. Only anticoagulant use (OR = 18.16; P = .08) was associated with a higher risk of overall mortality, although it was non-significant in univariate analysis. We emphasize that individualized treatment as well as prompt measurement should be implemented accordingly.
表现为小肠出血的 Dieulafoy 病变（DL）是一组罕见且潜在危及生命的预后不良疾病。已有几篇病例系列描述了这种情况，但对于已确诊的患者，最佳治疗方法和预测结果仍不清楚。
我们报告了一位 21 岁男性，因血性腹泻 1 天就诊。
腹部计算机断层扫描显示空肠有活性对比外渗和节段性壁增厚，内镜检查显示空肠近端有一个 15 毫米大小的黏膜下肿瘤。
由于生命体征不稳定，他接受了紧急经导管动脉栓塞治疗，随后外科医生在认为有潜在恶性的情况下进行了腹腔镜手术切除。病理科证实为空肠 DL 伴血栓形成。
他在住院第 8 天出院，无再出血。
对 1978 年以来 PubMed 上发表的 98 例病例进行了系统的文献回顾，发现有 DL 和小肠出血的患者主要累及空肠，其次是十二指肠和回肠。同时，DL 相关的十二指肠出血主要通过内镜检查和内镜干预诊断，而 DL 引起的空肠和回肠出血则通过内镜和手术检查，手术切除仍然是止血的选择。只有抗凝剂使用（OR=18.16；P=0.08）与总体死亡率增加相关，尽管在单因素分析中无统计学意义。我们强调，应根据具体情况实施个体化治疗和及时测量。
