Aralik 2023
Dieulafoy lezyonu saptanan hastalarin retrospektif analizi
Retrospective analysis of patients with Dieulafoy’s lesions
- Ana Sayfa
- Sayılar
- Aralik 2023
- Dieulafoy lezyonu saptanan hastalarin retrospektif analizi...
Özet
Giris ve Amaç: Gastrointestinal kanamalar klinik pratikte siklikla karsilasilan acil durumlardandir. Erken tani ve uygun tedavi esastir. Dieulafoy lezyonu etrafindaki mukozayi erode eden aberran submukozal damardir. Bu lezyonlar gastrointestinal kanamalarin %1-2’sine neden olur. Burada üst gastrointestinal kanama ile basvuran ve Dieulafoy lezyonu saptanan vakalarimizi sunacagiz. Gereç ve Yöntem: Agustos 2017-Agustos 2021 tarihleri arasinda üst gastrointestinal kanama nedeniyle hastanemize basvuran ve Dieulafoy lezyonu saptanan hastalar çalismaya alindi. Hastalarin dosyalari tarandi. Uygulanan tedaviler ve tedavi sonlanimlari kaydedildi. Bulgular: Çalismaya 30 hasta alindi. Ortalama yas 65.9 ± 18.2 (20 - 92) idi. Hastalarin yarisi kadindi. En sik basvuru sebepleri melana, hematemez ve hematokezya idi. Birlikte görülen hastaliklar hipertansiyon, aterosklerotik kalp hastaligi ve diabetes mellitus idi. Yirmi alti (%86.7) hastada Dieulafoy lezyonu ilk endoskopi ile tani konulabilirken, 4 hastada ise ikinci endoskopide tani konulabildi. Hastaneye basvuru ile ilk endoskopi arasindaki süre 3.1 ± 2.5 (1 - 10) saat idi. Yirmi üç hastada Dieulafoy lezyonu mide içerisinde, 6 hastada duodenumda ve 1 hastada da özofagusta görüldü. Tüm hastalara endoskopik tedavi yapildi. En sik uygulanan endoskopik tedavi modalitesi skleroterapi ve hemoklip uygulamasi idi. Bir hastada tekrarlayan kanama olmasi nedeniyle cerrahi gerekti. Alti hasta eksitus oldu. Bu hastalarin üçünde eksitus nedeni kanama ile iliskili idi. Sonuç: Dieulafoy lezyonu nadir fakat gastrointestinal kanamalarin önemli bir sebebidir. Erken tani ve uygun tedavi önemlidir. Tani için tekrarlayan endoskopi gerekli olabilir. Hemoklip uygulamasi skleroterapi ile veya skleroterapi olmaksizin ucuz, kolay, güvenli ve etkili bir tedavi yöntemidir.
Abstract
Background and Aims: Gastrointestinal bleeding is an emergent condition in clinical practice. Early diagnosis and proper treatment of the lesion is essential. Dieulafoy’s lesion is an aberrant submucosal vessel eroding surrounding mucosa. These lesions cause of 1-2% of all gastrointestinal bleedings. Here we report cases with Dieulafoy’s lesion presenting with upper gastrointestinal bleeding. Materials and Methods: Through a time frame of between August 2017-August 2021, patients admitted to our hospital presenting with upper gastrointestinal bleeding and diagnosed as Dieulafoy’s lesion were included in the study. Patients’ files were screened retrospectively. Results: The study included 30 patients with a mean age of 65.9 ± 18.2 (20 - 92) years. Half of them were female. The most observed presentations were melena, hematemesis, and hematochezia. Associated diseases were hypertension, atherosclerotic heart disease and diabetes mellitus. In 26 (86.7%) patients, Dieulafoy’s lesion was diagnosed in first endoscopy, while in four patients Dieulafoy’s lesion was diagnosed in second endoscopy. Time interval between hospital admission to first endoscopy was 3.1 ± 2.5 (1 - 10) hours. In 23 patients Dieulafoy’s lesion was in the stomach and in 6 patients in duodenum and in 1 patient in esophagus. Endoscopic therapy was applied to all patients. The most applied treatment modality was sclerotherapy + hemoclip application. One patient had required surgery due to recurrent bleeding. Six patients died. Three of them was bleeding related. Conclusion: Dieulafoy’s lesion is a rare but serious cause of gastrointestinal bleedings. Early diagnosis and proper treatment is important. Patients may need repeated endoscopy for diagnosis. Hemoclip application is cheap, easy, safe, and effective treatment modality with/without sclerotherapy.
