台灣外科醫學會雜誌

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篇名	Dieulafoy's Lesion in Second Portion of the Duodenum with Massive Bleeding
作者	Wen-Hsiang Chien, Sen-Ei Shai, Cheng-Chung Wu
卷期/出版年月	37卷6期 (2004/12)
頁次	276-280
摘要	Dieulafoy s lesion consists of an abnormally large submucosal artery often found in the stomach that tends to be acute, recurrent, and can lead to massive hemorrhage. Reported cases occurring in second portion of the duodenum are quite rare. We report a patient who developed melena 7 days after thoracoscopic operation due to secondary pneumothorax despite persistent H2-blocker IV injection since admission. Endoscopy revealed only stigmata with fresh blood streaming over the second portion of the duodenum near the ampula of Vater. Temporary hemostasis was performed by a local injection of epinephrine solution (1:10000). Emergent laparotomy was undertaken due to recurrent bleeding with unstable blood pressure six hours later. Further endoscopy failed because of massive blood clots impacted in the lower esophagus and whole stomach. Oversewn suture ligation of the bleeder by duodenotomy successfully treated the patient. The patient was discharged in stable condition and follow-up at 8 months revealed no further bleeding. The difficulties in diagnosis of the lesion and treatment options are discussed.
關鍵詞	Dieulafoy s lesion, second portion of the duodenum
分類	Case Report