ABSTRACT
Despite being a rare condition, Dieulafoy's lesion, also known as the persistent artery, is a serious cause of gastrointestinal bleeding. Only 1–2% of acute gastrointestinal bleeding is caused by it. Most commonly affects the stomach and duodenum, rarely affecting jejunum, ileum, caecum, etc. Our case presents a 21-year-old male who presented with lower gastrointestinal bleeding secondary to jejunal dieulafoy’s lesion.
ABSTRACT
Objective: Evaluate the hemodynamic characteristics of primitive carotid-vertebrobasilar anastomoses(PCVBA) by the combination of carotid duplex ultrasonography(CDU) and transcranial colorcoded sonography(TCCS). Methods: From July 2016 to July 2018, 14 patients combined screened by CDU and TCCS and confirmed by computed tomography angiography (CTA) in the Department of Neurology and Neurosurgery, Xuanwu Hospital were retrospectively and consecutively enrolled. The hemodynamic parameters, including peak systolic velocity (PSV) and resistance index (RI), were acquired in vertebral artery(VA).basilar artery(BA) and posterior cerebral artery. The vessel diameter of the extracranial VA was measured as well. Results: (1) Of 14 cases, 12 patients(12/14) represented dizziness, and 5 patients had posterior ischemic stroke, from whom there were 4 cases associated with ipsilateral internal carotid artery stenosis ≥50%. (2) Persistent trigeminal artery(PTA) was confirmed in 6 cases with high RI in bilateral extracranial VA. The velocity of distal BA was decreased when compressing the ipsilateral common carotid artery. (3)There were 5 persistent hypoglossal artery(PHA) and 3 proatlantal intersegmental artery (PIA), 1 case with type I PIA and 2 cases with type Jl PIA. CDU showed PHA and type I PIA arising from the extracranial internal carotid artery, and type II arising from the external carotid artery. All patients had ipsilateral VA absent, which has a tiny-lumen with low PSV and high RI or without flow, but TCCS showed normal blood flow in ipsilateral intracranial VA and BA, which was significantly decreased when compressing the ipsilateral common carotid artery. The contralateral VA were absent in 4 patients, and were hypoplastic in the other 4 patients. Conclusions: The abnormal hemodynamic changes of PCVBA could be evaluated by the combination of CDU and TCCS, which has a higher diagnostic accuracy of PHA and PIA than PTA. PHA or PIA have typical ultrasonographic manifestations, such as abnormal branches of the internal or external carotid artery on one side, and bilateral hypoplasia of extracranial VA with normal blood flow of ipsilateral intracranial VA and BA.
ABSTRACT
Objectives To explore the clinical diagnosis and treatment of Dieulafoy disease in children. Method The clinical features, endoscopic features and treatment of Dieulafoy disease in a child were reviewed. Results The 2-year-5-month old girl was admitted due to hematemesis for 7 hours. She was diagnosed of Dieulafoy disease by the typical endoscopic appearance. Gastroscopy showed that the lesion was located in gastric angle which was the predilection position of Dieulafoy disease. The small red blood vessels in the central part of the erosion area was exposed on the mucosal surface. The high frequency electrocoagulation under gastroscope was performed and effect was definite. Conclusion Dieulafoy disease is rare in children and lacks obvious clinical features. Endoscopic treatment has definite effect with little trauma and is the first choice of treatment.