십이지장 과형성 용종의 Dieulafoy양 병변에 대한 내시경적 Hemoclip 치료 1예
A Case of Endoscopic Hemoclip Management of Dieulafoy-like Lesion on the Hyperplastic Polyp in the Duodenum
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초록
Dieulafoy 병변은 위장관 출혈의 드문 원인이며, 위장관 출혈의 0.3～6.7%로 보고되고 있다. 대부분의 경우 위 식도 접합부 6 cm 이내의 위의 근위부에서 발생하고, 식도, 십이지장, 소장, 대장 및 직장 내에서도 드물게 발견되는 것으로 보고되고 있으며, 십이지장에서는 십이지장 구부가 대부분을 차지한다. 최근에는 내시경 치료술의 발달로 hemoclip을 이용하거나 고무 밴드 결찰술을 이용하여 좋은 치료 효과를 거두고 있는데특히, hemoclip의 경우 십이지장과 같이 상대적으로 장관벽이 얇고 내강이 좁은 경우에 대해 안전하고 효과적인 치료로 보고되고 있다. 저자들은 흑색변과 토혈을 주소로 내원한 47세 남자 환자에서 십이지장 제2부 근위부의 과형성 용종 위에 발생한 Dieulafoy양 병변을 발견하고 이를 hemoclip 요법을 통해 성공적으로 지혈하였으며, 이와 유사한 Dieulafoy양 병변의 보고가 드물기에 문헌 고찰과 함께 이를 보고하는 바이다.
Abstract
Dieulafoy's lesion (DL) is an uncommon but important cause of massive upper gastrointestinal bleeding that has been reported to be involved in 0.3∼6.7% of cases of major gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been observed in the esophagus, duodenum, small intestine, colon, and rectum. Most DLs encountered in the duodenum occur in the bulb. Recently, with the advances in endoscopic techniques, the successful management of DL has been achieved through the application of a hemoclip or elastic band ligation. In particular, the application of a hemoclip is considered to be a safe and effective treatment for DL located on a relatively narrow and thin walled canal such as the duodenum. We report the successful application of endoscopic hemoclipping for the treatment of a rare Dieulafoy-like lesion on a hyperplastic polyp in the 2nd portion of the duodenum. (Korean J Gastrointest Endosc 2007;34:329-333)
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