Multidisciplinary approach to acute massive gastrointestinal bleeding caused by Dieulafoy's lesion / 中华普通外科杂志

ABSTRACT

Objective To explore the multidisciplinary treatment for acute massive gastrointestinal (GI) bleeding caused by Dieulafoy's lesion.Methods The clinical data of 48 patients with Dieulafoy's lesions treated at our hospital from April 2007 to April 2012 were retrospectively analyzed.Of the 48 patients,40 were males and 8 were females,with a mean age of 46.7 years (range 21 -52 years).Accurate diagnosis was established by emergency upper gastrointestinal endoscopy, angiography and emergency laparotomy.Results The most common location of the bleeding Dieulafoy's lesion was at the body of stomach (40 cases),followed by the cardia (4 cases),the duodenum (2 cases) and the jejunum (2 cases ),with most lesions being located in the upper part of the stomach within 6 cm of the gastroesophageal junction.Correct diagnosis was made by endoscopy in 46 patients and by emergency laparotomy in 2 cases.Of the 18 patients initially treated endoscopically epinephrine injection and endoscopic hemoclips,2 cases needed angiography to identify the source of bleeding and were cured by transcatheter arterial embolization.23 patients underwent surgical therapy.In this series,47 cases were cured,1 patient died of hypovolaemic shock and multi-organ failure during the hospital stay.Average length hospital stay was (10.8 ± 2.5 ) d.Conclusions Dieulafoy' s lesion is less common cause of gastrointestinal bleeding.Endoscopy plays a key role in the diagnosis and treatment.Topical epinephrine injection and haemoclipping may cure the patients,if it fails angiography and embolization provides a therapy.Most patients may need a laparotomy and surgery as a decisive measure.