純エタノール局注療法にて止血しえた十二指腸球部Dieulafoy潰瘍の1例

概要

論文の詳細を見る
Dieulafoy's ulcer is known to cause abrupt massive hemorrhage due to arterial rupture, and is a mucosal defect although the defect is small and does not involve the deep layer. There are very few case reports of this disease in the duodenum. A 48-year-old male consulted our hospital for hematemesis and tarry stool. Physical examination on admission revealed decreased blood pressure and marked anemia. Endoscopy of the upper digestive tract revealed leaky hemorrhage from exposed blood vessels in a very small and shallow recess measuring 3 mm on the posterior wall of the duodenal bulb. The present case was diagnosed as Dieulafoy's ulcer, and topical injection therapy with 99% pure ethanol was performed. However, hemorrhage recurred on the following day. Additional injection of pure ethanol successfully achieved hemostasis. Endoscopy on the 7th hospital day revealed an extensive mucosal defect at the site, but exposed blood vessels had disappeared. The patient was discharged on the 25th hospital day. Injection therapy with pure ethanol is a safe and certain treatment that can be performed repeatedly. However, in patients with Dieulafoy's ulcer, additional hemorrhage may occur until exposed blood vessels have completely disappeared. These patients should be strictly followed and operated upon if necessary.
東京女子医科大学の論文
1997-10-25