RESUMO
A Dieulafoy's lesion (DL) is rare cause of acute gastrointestinal bleeding defined as a vascular abnormality of the submucosa. With a high prevalence for the stomach and upper gastrointestinal tract, it is rarely observed in the lower gastrointestinal tract. Its prevalence is rare accounting for less than 2% of all cases of acute gastrointestinal bleeding. The etiology of DL is unknown. Common comorbidities include cardiovascular disease, kidney disease, diabetes, alcohol abuse, liver disease, and chronic NSAID use. Few cases involving chronic steroid use and immunosuppressive treatment have been reported. The most common diagnostic and treatment modality is endoscopy with refractory cases treated with arterial embolization by angiography. We present a case involving a patient with significant comorbidities on chronic immunosuppression with a life-threatening, massive lower gastrointestinal bleed from a DL in the rectum.
Assuntos
Neoplasias Duodenais/patologia , Tumores do Estroma Gastrointestinal/patologia , Colangiopancreatografia por Ressonância Magnética , Diagnóstico Diferencial , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/cirurgia , Endossonografia , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Fígado/patologia , Esquistossomose Japônica/diagnóstico , Esquistossomose Japônica/patologia , Animais , Anti-Helmínticos/administração & dosagem , Biópsia , Feminino , Histocitoquímica , Humanos , Fígado/diagnóstico por imagem , Microscopia , Pessoa de Meia-Idade , Praziquantel/administração & dosagem , Radiografia Abdominal , Schistosoma japonicum/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
This case report describes the unusual presentation of a patient who had findings which were initially suggestive of a type IV choledochal cyst. Her liver biopsy demonstrated biliary cirrhosis. She was treated with endoscopic retrograde cholangiopancreatography and biliary stent exchanges over one year. Her cholangiogram one year later demonstrated resolution of the biliary cystic dilation which led to her initial diagnosis, with beading and stricturing of the hepatic ducts consistent with primary sclerosing cholangitis. Liver-associated enzymes and physical findings also improved. A liver biopsy one year later demonstrated a marked improvement in hepatic fibrosis with no evidence of cirrhosis.
