거짓동맥류를 동반한 구불결장 Dieulafoy 병변 출혈 1예
A Case of Dieulafoy's Lesion with Pseudoaneurysm in the Sigmoid Colon
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초록
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.
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.
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