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Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report
BACKGROUND: Dieulafoy’s lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa. There is usually no ulcer present in Dieulafoy’s lesions and the overlying mucosa is most often normal. Bleeding caused by a Dieulafoy’s lesi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642557/ https://www.ncbi.nlm.nih.gov/pubmed/33195675 http://dx.doi.org/10.12998/wjcc.v8.i20.5013 |
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author | He, Zhi-Wei Zhong, Ling Xu, Hui Shi, Hua Wang, Yang-Mei Liu, Xiao-Cong |
author_facet | He, Zhi-Wei Zhong, Ling Xu, Hui Shi, Hua Wang, Yang-Mei Liu, Xiao-Cong |
author_sort | He, Zhi-Wei |
collection | PubMed |
description | BACKGROUND: Dieulafoy’s lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa. There is usually no ulcer present in Dieulafoy’s lesions and the overlying mucosa is most often normal. Bleeding caused by a Dieulafoy’s lesion is usually urgent, massive, life-threatening and prone to recurrence. Dieulafoy’s lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum. However, a Dieulafoy’s lesion occurring inside a duodenal diverticulum is very rare. CASE SUMMARY: A 74-year-old Asian male with epigastric pain, hematemesis and melena was admitted to our clinic. Before admission, the patient had vomited 500 mL of dark red blood, and passed 200 g of black tarry stool. Conservative management was first undertaken as the patient had not been fasting. However, hemorrhage recurred and the patient went into shock. Urgent endoscopy was performed and a diverticulum of 1.8 cm × 1.2 cm × 0.8 cm was found on the anterior wall of the descending duodenum. The diverticulum was covered with a blood clot. After the clot was removed, an artery stump was observed in the diverticulum with a diameter of 2-3 mm. Two titanium hemostatic clips were inserted to clamp the vessel stump. The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence. CONCLUSION: This case was diagnosed with a Dieulafoy’s lesion inside a duodenal diverticulum which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips. No complications occurred. |
format | Online Article Text |
id | pubmed-7642557 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-76425572020-11-13 Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report He, Zhi-Wei Zhong, Ling Xu, Hui Shi, Hua Wang, Yang-Mei Liu, Xiao-Cong World J Clin Cases Case Report BACKGROUND: Dieulafoy’s lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa. There is usually no ulcer present in Dieulafoy’s lesions and the overlying mucosa is most often normal. Bleeding caused by a Dieulafoy’s lesion is usually urgent, massive, life-threatening and prone to recurrence. Dieulafoy’s lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum. However, a Dieulafoy’s lesion occurring inside a duodenal diverticulum is very rare. CASE SUMMARY: A 74-year-old Asian male with epigastric pain, hematemesis and melena was admitted to our clinic. Before admission, the patient had vomited 500 mL of dark red blood, and passed 200 g of black tarry stool. Conservative management was first undertaken as the patient had not been fasting. However, hemorrhage recurred and the patient went into shock. Urgent endoscopy was performed and a diverticulum of 1.8 cm × 1.2 cm × 0.8 cm was found on the anterior wall of the descending duodenum. The diverticulum was covered with a blood clot. After the clot was removed, an artery stump was observed in the diverticulum with a diameter of 2-3 mm. Two titanium hemostatic clips were inserted to clamp the vessel stump. The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence. CONCLUSION: This case was diagnosed with a Dieulafoy’s lesion inside a duodenal diverticulum which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips. No complications occurred. Baishideng Publishing Group Inc 2020-10-26 2020-10-26 /pmc/articles/PMC7642557/ /pubmed/33195675 http://dx.doi.org/10.12998/wjcc.v8.i20.5013 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Case Report He, Zhi-Wei Zhong, Ling Xu, Hui Shi, Hua Wang, Yang-Mei Liu, Xiao-Cong Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report |
title | Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report |
title_full | Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report |
title_fullStr | Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report |
title_full_unstemmed | Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report |
title_short | Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report |
title_sort | massive gastrointestinal bleeding caused by a dieulafoy’s lesion in a duodenal diverticulum: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642557/ https://www.ncbi.nlm.nih.gov/pubmed/33195675 http://dx.doi.org/10.12998/wjcc.v8.i20.5013 |
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