Tripathi Shikhar, Narayanagowda Rakesh, Das Sri Aurobindo Prasad, Jain Sunila, Nundy Samiran
Institute of Surgical Gastroenterology, GI & HPB Oncosurgery and Liver Transplant, Sir Ganga Ram Hospital, New Delhi, India.
Department of Pathology (Histopathology Division), Sir Ganga Ram Hospital, New Delhi, India.
Surg Case Rep. 2024 Nov 22;10(1):269. doi: 10.1186/s40792-024-02064-9.
A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation.
A 30-year-old male presented with sudden onset syncope and the passage of 200-300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy's lesion.
Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient's postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes.
空肠的Dieulafoy病是一种罕见的病变，但可能是胃肠道大出血的原因。其特征是一条粗大、迂曲的黏膜下动脉侵蚀覆盖其上的上皮，由于其非典型的位置和表现，在诊断和治疗上具有挑战性。
一名30岁男性突发晕厥，排出200 - 300毫升混有鲜血的粪便。他没有重大合并症，血压为80/50 mmHg，出现低血压，需要立即输注3单位浓缩红细胞。包括上消化道内镜检查和结肠镜检查在内的初步内镜评估未能找到出血源。CT血管造影确定空肠第一分支有活动性出血，随后进行了线圈栓塞。持续的症状促使进行胶囊内镜检查，发现空肠近端有血管扩张。尽管应用了止血夹并总共输注了11单位血液，但他的症状仍持续存在。然后他接受了腹腔镜切除含有息肉的空肠段，随后进行了体外空肠 - 空肠吻合术。组织病理学证实为良性息肉伴中央溃疡，符合Dieulafoy病的病变特征。
CT血管造影和胶囊内镜等先进的诊断技术在定位出血源方面发挥了关键作用。当侵入性较小的方法失败时，手术干预被证明是治愈性的。患者术后恢复顺利，突出了多学科方法的有效性。高度的怀疑指数和多学科方法对于取得成功的结果至关重要。
