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病例报告:犬胃黏膜Dieulafoy病变的首次描述。

Case report: The first description of a Dieulafoy's lesion in the gastric mucosa of a dog.

作者信息

Barrantes Murillo Daniel Felipe, Tillson Michael, Koehler Jennifer W, Sandey Maninder

机构信息

Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.

Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.

出版信息

Front Vet Sci. 2022 Aug 22;9:932435. doi: 10.3389/fvets.2022.932435. eCollection 2022.

DOI:10.3389/fvets.2022.932435
PMID:36072394
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9441867/
Abstract

An approximately 12-year-old, 31 kg, male neutered Labrador Retriever was presented to the referring hospital with an acute onset (less than 1 day) of hematemesis and melena. The dog was treated supportively for a presumptive gastric ulcer for 4 days with intravenous fluids, gastro protectants, such as pantoprazole, misoprostol, sucralfate, and barium, as well as an anti-emetic (maropitant) and analgesics (fentanyl, gabapentin, and tramadol). Throughout medical management, the dog continued to require blood transfusions approximately every 24 h. Given the poor medical response, the patient was subjected to an exploratory laparotomy. During surgery, a grossly raised, blister-like lesion on the mucosal surface of the stomach was appreciated on the lesser curvature of the stomach. A partial gastrectomy was performed, and the segment was submitted for histological evaluation. Histologically, there were multiple, tortuous, medium-caliber muscular arteries (>1.0 mm in diameter) in the submucosa. A single large-caliber artery (>0.75 mm in diameter) containing a partially occlusive thrombus extruded through the mucosa and projected on the ulcerated surface. The patient's signs were similar clinically and histopathologically to Dieulafoy's lesion in people. A Dieulafoy's lesion is a potentially life-threatening disorder that causes gastrointestinal (GI) hemorrhage. This lesion is characterized by a dilated, large-caliber, aberrant submucosal artery that erodes through the epithelium and ruptures, resulting in massive and potentially fatal hemorrhage. This lesion has never been documented previously in a dog.

摘要

一只约12岁、体重31千克的已绝育雄性拉布拉多猎犬被转诊至医院,出现急性(不到1天)呕血和黑便症状。该犬因疑似胃溃疡接受了4天的支持性治疗,包括静脉输液、使用胃保护剂(如泮托拉唑、米索前列醇、硫糖铝和钡剂)、止吐药(马罗匹坦)和镇痛药(芬太尼、加巴喷丁和曲马多)。在整个治疗过程中,该犬大约每24小时就需要输血一次。鉴于治疗效果不佳,对该患者进行了剖腹探查术。手术过程中,在胃小弯处发现胃黏膜表面有一个明显隆起的水泡样病变。进行了部分胃切除术,并将切除部分送去做组织学评估。组织学检查显示,黏膜下层有多个迂曲的中等口径肌性动脉(直径>1.0毫米)。一条直径>0.75毫米的大口径动脉内有一个部分阻塞性血栓,血栓穿过黏膜突出到溃疡表面。该患者的临床症状和组织病理学表现与人的Dieulafoy病变相似。Dieulafoy病变是一种可能危及生命的疾病,可导致胃肠道出血。该病变的特征是黏膜下动脉扩张、口径大且异常,它会侵蚀上皮并破裂,导致大量出血,甚至可能致命。此前从未有过该病变在犬类中的报道。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/d6c608e02502/fvets-09-932435-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/1d9dde316db0/fvets-09-932435-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/7ee10d189e41/fvets-09-932435-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/d6c608e02502/fvets-09-932435-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/1d9dde316db0/fvets-09-932435-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/7ee10d189e41/fvets-09-932435-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83b1/9441867/d6c608e02502/fvets-09-932435-g0003.jpg

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Cureus. 2020 Jul 13;12(7):e9170. doi: 10.7759/cureus.9170.
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Dieulafoy lesion: the little known sleeping giant of gastrointestinal bleeds.
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Clin Endosc. 2015 May;48(3):228-33. doi: 10.5946/ce.2015.48.3.228. Epub 2015 May 29.
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