만성 신부전 환자에서 위와 직장의 Dieulafoy양병변에 의한 위장관 출혈 1예
A Case of Gastrointestinal Bleeding Caused by Dieulafoy-like Lesions of the Stomach and Rectum in a Patient with Chronic Renal Failure
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Dieulafoy 궤양은 작은 점막 병변 내로 노출된 혈관으로부터 심한 위장관 출혈을 일으키는 질환으로 대부분의 병변은 위의 상부에서 발견되지만 드물게 같은 병변이 십이지장, 소장, 대장에서도 관찰된다. 저자들은 흑색변을 주소로 내원한 만성 신부전을 동반한 78세 여자 환자에서 위에 Dieulafoy양 병변을 관찰하고 내시경적 hemoclipping을 시행하여 성공적으로 지혈하였다. 경과 관찰 중 직장에 발생한 Dieulafoy양 병변에서 대량의 위장관 출혈이 발생하여 내시경적 밴드결찰술로 초기 지혈에 성공하였으나 밴드가 탈락된 후 생긴 궤양에서 재출혈하여 궤양부위를 국소절제하고 일차봉합하여 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Abstract
Dieulafoy's lesion is a very rare cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The majority of lesions are found in the stomach, but rarely it has also been identified in the duodenum, small bowel, colon and rectum. We describe a 78-year-old female with chronic renal failure who presented with melena and was subsequently found to have a Dieufaloy-like lesion in the stomach. The bleeding was successfully managed by endoscopic hemoclipping. During the follow-up, massive gastrointestinal bleeding was developed by a Dieulafoy-like lesion in the rectum. This lesion was managed by endoscopic band ligation, but there was recurrent bleeding from the ulcer site. The ulcer site was locally excised and primary closure was carried out.
참고문헌 (20)
- "Dieulafoy's lesion:diagnosis and management", 36, pp.1702~1707 (1991)
- "Dieulafoy's disease", 196, pp.290~296 (2003)
- "직장에서의 Dieulafoy양 병변", 27, pp.261~266 (1995)
- "Endoscopic management of Dieulafoy lesions of the stomach: a case study of 26 patients", 29, pp.834~839 (1997)
- "Endoscopic treatment of lower gastrointestinal bleeding", 18, pp.87~93 (2002)
- "Massive rectal bleeding from a Dieulafoy's type ulcer of the rectum:a review of this unusual disease", 86, pp.1545~1547 (1991)
- "Recurrent massive haematemesis from Dieulafoy vascular malformations-a review of 101 cases", 27, pp.213~222 (1986)
- "Dieulafoy-like lesion of the rectum presenting with exsanguinating hemorrhage:successful endoscopic sclerotherapy", 88, pp.1939~1941 (1993)
- "Dieulafoy's disease:endoscopic treatment and follow up", 34, pp.1418~1421 (1993)
- "Dieulafoy's lesion of the rectum", 1, pp.146~147 (1997)
- "Dieulafoy's disease:a distinct clinical entity", 54, pp.337~339 (1984)
- "Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon", 90, pp.108~111 (1995)
- "Rectal Dieulafoy's or angiodysplasia?", 46, pp.91~92 (1997)
- "Recurrent rectal bleeding from portal hypertensive colopathy in a patient with hemorrhoids", 90, pp.1531~1533 (1995)
- "Short-term and long-term benefits of endoscopic hemoclip application for Dieulafoy's lesion in the upper GI tract", 57, pp.653~656 (2003)
- "Bleeding Dieulafoy's lesions and the choice of endoscopic method:comparing the hemostatic efficacy of mechanical and injection methods", 52, pp.721~724 (2000)
- "Dieulafoy- like lesions of colon and rectum in patients with chronic renal failure on long-term hemodialysis", 46, pp.3121~3123 (1999)
- "Upper gastrointestinal bleeding in patients with chronic renal failure:role of vascular ectasia", 91, pp.2329~2332 (1996)
- "Uremic bleeding:pathogenesis and therapy", 316, pp.94~104 (1998)
- "Hematologic aspects of end-stage renal failure", 69, pp.33~40 (1994)