Seyrek görülen bir üst gastrointestinal sistem kanama nedeni: Dieulafoy lezyonu
Küçük Resim Yok
Tarih
1998
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Dieulafoy lezyonu sık aralarla ve ciddi derecede kanayan, makroskopik olarak lümene çıkıntılı, yeni vakalarda üzerinde pıhtı bulunan arteriel damar lezyonudur. Kliniğimizde 1994-1996 yıllarında varis dışı üst gis kanama tanısı ile izlenen 515 hastadan 12'sinde (% 2.3) Dieulafoy lezyonu saptandı. Bu vakaların klinik özellikleri retrospektif olarak incelenmiştir. Olguların 8'si erkek, 4'ü kadın ortalama yaş 59±18 ve tümünün hastaneye geliş nedeni hematemez melena idi. Yatışta hastaların hemoglobin değerleri 5-10 g/dL arasında değişmekteydi. Kliniğimizde izlendiği sürede yapılan kan transfüzyonu 3-10 ünite arasında değişmekteydi. Hastaların 8'inde ek sistemik hastalık saptandı. Endoskopik olarak 8 vakada lezyon proksimal korpusta, 3'ünde fundusta ve l'inde kardiada olduğu görüldü. Hastaların 7 sinde endoskopi sırasında aktif kanama mevcuttu, 5 vakada üzeri pıhtılı damar görüldü. Tüm hastalara endoskopik skleroterapi yapıldı (Adrenalin 1/10.000 ve polidocanol % 1). İlk skleroterapiden sonra 2 hastada kanama tekrarladı; bunlardan birinde müteakip yapılan skleroterapilerle kanama kontrol altına alınamadı, cerrahiye verilen hasta operasyon sırasında kaybedildi. Sonuç olarak; Dieulafoy lezyonu tedavisinde endoskopik skleroterapi genelde başarılıdır. Özellikle sık tekrarlayan ve endoskopide kanama nedeni tam belirlenemeyen vakalarda bu tanı daima akılda tutulmalıdır.
Dieulafoy's disease is an arterial lesion with is frequent and serious bleeding and in new cases it is macroscopically protruding into the intestial lumen having clot on its surface. in our clinic, between 1994 and 1996, Dieulafoy's disease was identified in 12 (2.3%) of 515 patients followed by the diagnosis of upper gastrointestinal bleeding without having varices. the clinical features of these cases were retrospectively analyzed. There were 8 males and 4 females, average ages 59±18. the reasons for applying to the hospital were hematemesis and melena in all patients. Hemoglobin values were between 5 to 10 g/dL at the hospitalization and blood transfusion during follow-up in the clinic was between 3 to 10 units. Additional systemic disease was diagnosed in 8 patients. Endoscopicaly the lesion was at the proximal corpus in 8, fundus in 3 and cardia in 1 case. During endoscopy, active bleeding was observed in 7 cases and in 5 cases, a vessel having clot on its surface was identified. Endoscopic injection sclerotherapy (Adrenalin 1/10.000, polidocanol % 1) was the treatment in all cases. Bleeding recurred in 2 cases after initial sclerotherapy. in one of these two cases, bleeding could not be stopped even after second sclerotherapy and the patient died during surgery. Sclerotherapy is generally successful in the treatment of Dieulafoy's disease. the diagnosis of Dieulafoy's disease should be remembered in cases of frequently recurring hemorrhage having unidentified reason endoscopically.
Dieulafoy's disease is an arterial lesion with is frequent and serious bleeding and in new cases it is macroscopically protruding into the intestial lumen having clot on its surface. in our clinic, between 1994 and 1996, Dieulafoy's disease was identified in 12 (2.3%) of 515 patients followed by the diagnosis of upper gastrointestinal bleeding without having varices. the clinical features of these cases were retrospectively analyzed. There were 8 males and 4 females, average ages 59±18. the reasons for applying to the hospital were hematemesis and melena in all patients. Hemoglobin values were between 5 to 10 g/dL at the hospitalization and blood transfusion during follow-up in the clinic was between 3 to 10 units. Additional systemic disease was diagnosed in 8 patients. Endoscopicaly the lesion was at the proximal corpus in 8, fundus in 3 and cardia in 1 case. During endoscopy, active bleeding was observed in 7 cases and in 5 cases, a vessel having clot on its surface was identified. Endoscopic injection sclerotherapy (Adrenalin 1/10.000, polidocanol % 1) was the treatment in all cases. Bleeding recurred in 2 cases after initial sclerotherapy. in one of these two cases, bleeding could not be stopped even after second sclerotherapy and the patient died during surgery. Sclerotherapy is generally successful in the treatment of Dieulafoy's disease. the diagnosis of Dieulafoy's disease should be remembered in cases of frequently recurring hemorrhage having unidentified reason endoscopically.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Turkish Journal of Gastroenterology
WoS Q Değeri
Scopus Q Değeri
Cilt
9
Sayı
2
