Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Acta Med Indones. 2023 Apr;55(2):201-204.
Dieulafoy lesion is a rare condition that usually occurs in cases of gastric bleeding in the upper gastrointestinal tract. However, this condition can also occur in the lower gastrointestinal tract but less frequently. The lesion is an arteriolar malformation that extends to the submucosa, causing erosion and bleeding. Meanwhile, this is a case of a 67-year-old woman presenting with a bright red bloody stool prior to admission, as well as a history of constipation which was relieved by digital stool evacuation two weeks earlier. The medical history of the patient reveals episodes of repeated ischaemic stroke for over seven years and three months, which has led to other conditions such as right-sided paralysis, transcortical motor aphasia, and neurogenic dysphagia. The patient was routinely on antithrombotic medications, which was stopped during hospitalisation where repeated packed cell transfusion was done in order to avoid hematochezia. The patient needed the support of her caregiver most of the time since she was bedridden. Furthermore, the haemostasis and platelet function of the patient were normal. On colonoscopy, there was the discovery of a small lesion of about 3mm in her rectum, protruding into the lumen and pulsated, which was discovered to be Dieulafoy's lesion. Subsequently, this lesion was closed using rubber band ligation, and after a month, there was no recurrence of the lower gastrointestinal bleeding.
Dieulafoy 病变是一种罕见的疾病，通常发生在上消化道胃出血的情况下。然而，这种情况也可能发生在下消化道，但不太常见。病变是一种延伸到黏膜下层的小动脉畸形，导致侵蚀和出血。同时，这是一例 67 岁女性，入院前出现鲜红色血便，两周前曾有过便秘，通过手指抠粪缓解。患者的病史显示，七年来反复发生缺血性中风，导致右侧瘫痪、皮质运动性失语和神经性吞咽困难等其他情况。患者常规服用抗血栓药物，住院期间为避免血便而停止使用。患者大部分时间都需要护理人员的支持，并且卧床不起。此外，患者的止血和血小板功能正常。结肠镜检查发现直肠内有一个约 3mm 的小病变，向管腔突出并搏动，诊断为 Dieulafoy 病变。随后，使用橡皮圈结扎封闭该病变，一个月后，下消化道出血未再复发。
