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结肠杜氏病作为下消化道出血的罕见原因

Colonic Dieulafoy Lesion as a Rare Cause of Lower Gastrointestinal Bleeding.

作者信息

Farag Mohamed, Diaz Yordanka, Patel Harish

机构信息

Internal Medicine Department, Bronxcare HealthSystem, Bronx, NY, USA.

出版信息

Case Rep Gastroenterol. 2025 Jan 31;19(1):52-56. doi: 10.1159/000542790. eCollection 2025 Jan-Dec.

Abstract

INTRODUCTION

Dieulafoy lesion is one of the most under-recognized sources of gastrointestinal (GI) bleeding (GI), typically manifesting as acute upper gastrointestinal bleeding; endoscopy is usually the first diagnostic and therapeutic modality utilized to handle these lesions by employing a variety of procedures.

CASE REPORT

This is a case of an 81-year-old female who was being assessed after experiencing repeated bouts of melena with hemoglobin drop. The patient had multiple comorbidities but no history of gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) revealed only Erythematous duodenopathy without active bleeding; the initial colonoscopy revealed a large amount of blood without identifying the source of bleeding; a second colonoscopy revealed classic Dieulafoy lesions in the splenic flexure, which were injected and clipped, and the bleeding ceased.

CONCLUSION

Dieulafoy lesions are most frequently found in the stomach and gastroesophageal junction, but they have also been documented in other parts of the gastrointestinal tract. In this particular instance, the lesions were identified in the colon, which is an unusual location for them, and they were treated endoscopically by clipping and injecting. In conclusion, colonic Dieulafoy lesions, although rare, have the potential to cause life-threatening bleeding and should be included in the differential diagnosis of lower gastrointestinal bleeding.

摘要

引言

Dieulafoy病变是胃肠道(GI)出血最易被忽视的原因之一,通常表现为急性上消化道出血;内镜检查通常是通过采用多种操作来处理这些病变的首要诊断和治疗方式。

病例报告

这是一例81岁女性患者,在经历多次黑便伴血红蛋白下降后接受评估。该患者有多种合并症,但无胃肠道出血史。食管胃十二指肠镜检查(EGD)仅显示十二指肠红斑病,无活动性出血;初次结肠镜检查发现大量血液,但未确定出血来源;第二次结肠镜检查发现脾曲有典型的Dieulafoy病变,对其进行了注射和钳夹处理,出血停止。

结论

Dieulafoy病变最常发生于胃和胃食管交界处,但也有在胃肠道其他部位的报道。在这个特殊病例中,病变在结肠被发现,这对它们来说是一个不寻常的位置,并且通过钳夹和注射进行了内镜治疗。总之,结肠Dieulafoy病变虽然罕见,但有可能导致危及生命的出血,应纳入下消化道出血鉴别诊断范围。

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