Balserak J C, Neal D
University of Arizona Health Science Center, Tucson, USA.
Surg Laparosc Endosc. 1996 Feb;6(1):68-70.
We present a case report of a 69-year-old man with multiple medical problems who presented to the Veterans Hospital in Tucson, Arizona, with recurrent upper gastrointestinal bleeding following multiple upper endoscopic attempts at chemical injection and thermal coagulation of several vascular malformations of the duodenum. Intraoperative endoscopy was employed to identify the location of three small mucosal lesions. By employing transmural endoscopic illumination and direct endoscopic visualization we identified all arteriovenous malformations and then ligated them with silk ligatures from the bowel wall exterior during surgical exploration, avoiding duodenotomy and duodenectomy. The patient has had an uneventful recovery with no evidence of recurrent bleeding at a 1-year follow-up.
我们报告一例69岁男性患者，他有多种内科疾病，因十二指肠多处血管畸形经多次上消化道内镜下化学注射和热凝治疗后仍反复出现上消化道出血，前往亚利桑那州图森市的退伍军人医院就诊。术中内镜用于确定三个小黏膜病变的位置。通过采用透壁内镜照明和直接内镜观察，我们识别出所有动静脉畸形，然后在手术探查期间从肠壁外部用丝线结扎，避免了十二指肠切开术和十二指肠切除术。患者恢复顺利，1年随访时无复发出血迹象。
