- 期刊
Dieulafoy's Lesion in Second Portion of the Duodenum with Massive Bleeding
十二指腸第二部份的杜雷夫氏病變合併大量出血
摘要
杜雷夫氏疾病是一種較大型黏膜下血管的異常,通常是發現在胃部,且容易造成急性、復發性的大量出血。文獻報告的病例中，發生在十二指腸第二部分的相當少。我們報告一位病例，因續發性氣胸接受過胸腔鏡，手術後七天發生黑便，雖然病人自住院開始就持續給予針劑的H2-blocker胃酸阻斷劑，內視鏡檢查僅發現在十二指腸第二部位接近壺腹的地方有一持續冒鮮血的紫瘢，而其他部位均無異常。經由內視鏡在出血周圍給予局部注射(1:10000)腎上腺素暫時止血，但六小時後，因再次出血造成血壓不穩定，且再一次的內視鏡因大量血塊阻塞在下食道及整個胃部而告失敗。所以，病人接受緊急開腹手術，做十二指腸切開術，在出血點處做縫合結扎手術而成功的治療。病人出院時狀況穩定，且經過八個多月的追蹤，沒有再出血。對此疾病的診斷困難及治療選擇，我們在此報告中做深入探討。
關鍵字
無資料並列摘要
Dieulafoy's lesion consists of an abnormally large submucosal artery often found in the stomach that tends to be acute, recurrent, and can lead to massive hemorrhage. Reported cases occurring in second portion of the duodenum are quite rare. We report a patient who developed melena 7 days after thoracoscopic operation due to secondary pneumothorax despite persistent H2-blocker IV injection since admission. Endoscopy revealed only stigmata with fresh blood streaming over the second portion of the duodenum near the ampula of Vater. Temporary hemostasis was performed by a local injection of epinephrine solution (1:10000). Emergent laparotomy was undertaken due to recurrent bleeding with unstable blood pressure six hours later. Further endoscopy failed because of massive blood clots impacted in the lower esophagus and whole stomach. Oversewn suture ligation of the bleeder by duodenotomy successfully treated the patient. The patient was discharged in stable condition and follow-up at 8 months revealed no further bleeding. The difficulties in diagnosis of the lesion and treatment options are discussed.