Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Case of Dieulafoy's Lesion with Pseudoaneurysm in the Sigmoid Colon

거짓동맥류를 동반한 구불결장 Dieulafoy 병변 출혈 1예

  • Kim, Tae-Wan (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hong-Joo (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Min, Jae-Hoon (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Byun, Sun-Jeong (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Ji-Ae (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jang, Seung-Hun (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Sung-Youn (Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김태완 (성균관대학교 의과대학 강북삼성병원 내과학교실) ;
  • 김홍주 (성균관대학교 의과대학 강북삼성병원 내과학교실) ;
  • 민재훈 (성균관대학교 의과대학 강북삼성병원 내과학교실) ;
  • 변선정 (성균관대학교 의과대학 강북삼성병원 내과학교실) ;
  • 이지애 (성균관대학교 의과대학 강북삼성병원 내과학교실) ;
  • 장승훈 (성균관대학교 의과대학 강북삼성병원 내과학교실) ;
  • 최성연 (성균관대학교 의과대학 강북삼성병원 내과학교실)
  • Received : 2010.03.07
  • Accepted : 2010.08.04
  • Published : 2010.11.30
⟨ Previous Next ⟩

Abstract

Dieulafoy's lesions are characterized by a single large tortuous arteriole in the submucosa, and this arteriole does not undergo normal branching. These lesions are an uncommon cause of massive, sometimes fatal gastrointestinal bleeding; this had been reported to be the cause of 0.3~1.5% of the cases of major gastrointestinal bleeding. The lesions mainly occur in the proximal stomach, but they may occur in all parts of the gastrointestinal tract, including the small bowel, colon and rectum. Endoscopy is a common method for the diagnosis and treatment of Dieulafoy's lesions. However, in the case of a high risk lesion, angiography, laparoscopy or laparotomy can be performed instead. We experienced a rare case of bleeding from a Dieulafoy's lesion with pseudoaneurysm in the sigmoid colon. Angiography with embolization was performed, but the patient expired due to rebleeding. We report on this case along with a review of the relevant literature.

Dieulafoy 병변은 작은 점막 결손 부위를 통해 점막하 세동맥이 위장관으로 노출되어 출혈을 유발하는 질환으로, 대량 위장관 출혈의 드문 원인이다. 주로 위장 근위부에서 발생하나 드물게 식도, 소장, 대장과 같이 전 위장관에서도 발생할 수 있다. 내시경이 진단과 치료에 우선적이나 위험군의 경우 혈관조영술이나 수술을 하기도 한다. 이번 증례는 구불결장이라는 드문 위치에 발생한 Dieulafoy 병변에 거짓동맥류가 동반된 경우로 저자들은 혈관조영술로 확인하여 색전술을 시행한 후 초기 치료는 성공적이었으나 3일 후 재출혈로 결국 사망하였다.

Keywords

References

  1. Fockens P, Tytgat GN. Dieulafoy's disease. Gastrointest Endosc Clin N Am 1996;6:739-752.
  2. Lee HL, Yoon BC, Byun TJ, et al. A case of Dieulafoy's lesion of the jejunum presenting with massive gastrointestinal bleeding. Korean J Gastroenterol 2002;39:123-127.
  3. Rhim JW, Kim YS, Park JO. A case of Dieulafoy's lesion in duodenal bulb. Korean J Pediatr 2004;47:343-346.
  4. Lim YJ, Do IG, Kim YH. A case of Dieulafoy lesion in the jejunum. Korean J Gastroenterol 2008;51:67-69.
  5. Schmulewitz N, Baillie J. Dieulafoy lesion: a review of 6 years of experience at a tertiary referral center. Am J Gastroenterol 2001;96:1688-1694. https://doi.org/10.1111/j.1572-0241.2001.03922.x
  6. Sone Y, Kumada T, Toyoda H, Hisanaga Y, Kiriyama S, Tanikawa M. Endoscopic management and follow up of Dieulafoy lesion in the upper gastrointestinal tract. Endoscopy 2005;37:449-453. https://doi.org/10.1055/s-2005-861288
  7. Veldhuyzen van Zanten SJ, Bartelsman JF, Schipper ME, Tytgat GN. Recurrent massive haematemesis from Dieulafoy vascular malformation: a review of 101 cases. Gut 1986;27:213-222. https://doi.org/10.1136/gut.27.2.213
  8. Miko TL, Thomazy VA. The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy's lesion, and submucosal arterial malfomation. Hum Pathol 1988;19:914-921. https://doi.org/10.1016/S0046-8177(88)80006-6
  9. McClave SA, Goldschmid S, Cunningham JT, Boyd WP Jr. Dieulafoy's cirsoid aneurysm of the duodenum. Dig Dis Sci 1988;33:801-805. https://doi.org/10.1007/BF01550966
  10. Juler GL, Labitzke HG, Lamb R, Allen R. The pathogenesis of Dieulafoy's gastric erosion. Am J Gastroenterol 1984;79:195-200.
  11. Abdulian JD, Santoro MJ, Chen YK, Collen MJ. Dieulafoy-like lesion of the rectum presenting with exsanguinating hemorrhage: successful endoscopic sclerotherapy. Am J Gastroenterol 1993;88:1939-1441.
  12. Franko E, Chardavoyne R, Wise L. Massive rectal bleeding from a Dieulafoy's type ulcer of the rectum: a review of this unusual disease. Am J Gastroenterol 1991;86:1545-1547.
  13. Reilly HF 3rd, al-Kawas FH. Dieulafoy's lesion: diagnosis and management. Dig Dis Sci 1991;36:1702-1707. https://doi.org/10.1007/BF01296613
  14. Dy NM, Gostout CJ, Balm RK. Bleeding from the endoscopically-indentified Dieulafoy lesion of the proximal small intestine and colon. Am J Gastroenterol 1995;90:108-111.
  15. Kim JH, Kim JS, Kim CD, et al. Clinical features of pseudoaneurysms complicating pancreatitis: single center experience and review of Korean literature. Korean J Gastroenterol 2007;50:108-115.
  16. Jung SW, Son HS, Kim JH, et al. A case of duodenal Dieulafoy's lesion treated with coil embolization. Korean J Med 2006;70:118-122.
  17. Rosch J, Keller FS, Kozak B, Niles N, Dotter CT. Gelfoam powder embolization of the left gastric artery in treatment of massive small-vessel gastric bleeding. Radiology 1984;151:365-370. https://doi.org/10.1148/radiology.151.2.6608749
  18. Toyoda H, Nakano S, Kumada T, et al. Estimation of usefulness of N-butyl-2-cyanoacrylate-lipiodol mixture in transcatheter arterial embolization for urgent control of life-threatening massive bleeding from gastric or duodenal ulcer. J Gastroenterol Hepatol 1996;11:252-258. https://doi.org/10.1111/j.1440-1746.1996.tb00071.x
  19. Maleux G, van Steenbergen W, Stockx L, Vanbeckevoort D, Wilms G, Marchal G. Multiple small pseudoaneurysms complicating pancreatitis: angiographic diagnosis and transcatheter embolization. Eur Radiol 2000;10:1127-1129. https://doi.org/10.1007/s003309900262
  20. Katsinelos P, Pilpilidis I, Paroutoglou G, et al. Dieulafoy-like lesion of the colon presenting with massive lower gastrointestinal bleeding. Surg Endosc 2004;18:346.