Treatment of ileal Dieulafoy's lesion by hemostatic clips under double-balloon enteroscopy: a case report.

IF 3 4区 医学 Q1 Medicine Translational gastroenterology and hepatology Pub Date : 2023-01-01 DOI:10.21037/tgh-22-14
Cong Gao, Xiaozhong Guo, Hongyu Li, Hongxin Chen, Zhenjiao Gao, Fei Gao, Xingshun Qi
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Abstract

Background: Small intestinal Dieulafoy's lesion (DL) is a rare cause of life-threatening gastrointestinal bleeding. Based on previous case reports, the diagnostic approaches for DL located in jejunum and ileum are different. In addition, there is no available consensus regarding the treatment of DL, and previous case reports suggest that surgery is the preferable choice for small intestinal DL compared to endoscopic treatment. Notably, our case report indicates that double-balloon enteroscopy (DBE) should be an effective diagnostic and therapeutic approach for small intestinal DL.

Case description: A 66-year-old female was transferred to the Department of Gastroenterology due to hematochezia and abdominal distension and pain for more than 10 days. She had a history of diabetes, hypertension, coronary heart disease, atrial fibrillation, mitral insufficiency, and acute cerebral infarction. Conventional diagnostic approaches, including gastroduodenoscopy, colonoscopy, and even angiogram, did not show any definite source of bleeding, and then a capsule endoscopy was performed and suggested that the bleeding may be located in ileum. Finally, she was successfully treated by hemostatic clips under DBE via anal route. And there is no recurrence after endoscopic treatment was observed in our case during a 4-month follow-up.

Conclusions: Although small intestinal DL is rare and difficult to be detected by conventional approaches, DL still needs to be considered as a differential diagnosis for gastrointestinal bleeding. In addition, DBE should be considered as a preferred choice for the diagnosis and treatment of small intestinal DL due to lower invasiveness and cost as compared to surgery.

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双球囊肠镜下止血夹治疗回肠十二指肠溃疡1例。
背景:小肠diulafoy病变(DL)是一种罕见的危及生命的胃肠道出血原因。根据以往的病例报告,位于空肠和回肠的DL的诊断方法不同。此外,对于DL的治疗尚无共识,以前的病例报告表明,与内窥镜治疗相比,手术是小肠DL的更好选择。值得注意的是,我们的病例报告表明,双气囊肠镜检查(DBE)应该是小肠DL的有效诊断和治疗方法。病例描述:66岁女性,因便血、腹胀疼痛10余天,转至消化内科就诊。患者有糖尿病、高血压、冠心病、心房颤动、二尖瓣功能不全、急性脑梗死等病史。传统的诊断方法,包括胃十二指肠镜,结肠镜,甚至血管造影,都没有显示出任何明确的出血来源,然后进行了胶囊内镜检查,提示出血可能位于回肠。最后经肛门经DBE下止血夹治疗成功。本病例随访4个月,内镜治疗后无复发。结论:虽然小肠DL罕见且难以被常规方法发现,但DL仍需作为胃肠道出血的鉴别诊断。此外,与手术相比,DBE具有较低的侵入性和较低的费用,因此应考虑作为小肠DL诊断和治疗的首选。
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来源期刊
CiteScore
8.20
自引率
0.00%
发文量
1
期刊介绍: Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.
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