Dieulafoy lezyonu saptanan hastaların retrospektif analizi

Öz

Giriş ve Amaç: Gastrointestinal kanamalar klinik pratikte sıklıkla karşılaşılan acil durumlardandır. Erken tanı ve uygun tedavi esastır. Dieulafoy lezyonu etrafındaki mukozayı erode eden aberran submukozal damardır. Bu lezyonlar gastrointestinal kanamaların %1-2’sine neden olur. Burada üst gastrointestinal kanama ile başvuran ve Dieulafoy lezyonu saptanan vakalarımızı sunacağız. Gereç ve Yöntem: Ağustos 2017-Ağustos 2021 tarihleri arasında üst gastrointestinal kanama nedeniyle hastanemize başvuran ve Dieulafoy lezyonu saptanan hastalar çalışmaya alındı. Hastaların dosyaları tarandı. Uygulanan tedaviler ve tedavi sonlanımları kaydedildi. Bulgular: Çalışmaya 30 hasta alındı. Ortalama yaş 65.9 ± 18.2 (20 - 92) idi. Hastaların yarısı kadındı. En sık başvuru sebepleri melana, hematemez ve hematokezya idi. Birlikte görülen hastalıklar hipertansiyon, aterosklerotik kalp hastalığı ve diabetes mellitus idi. Yirmi altı (%86.7) hastada Dieulafoy lezyonu ilk endoskopi ile tanı konulabilirken, 4 hastada ise ikinci endoskopide tanı konulabildi. Hastaneye başvuru ile ilk endoskopi arasındaki 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 yapıldı. En sık uygulanan endoskopik tedavi modalitesi skleroterapi ve hemoklip uygulaması idi. Bir hastada tekrarlayan kanama olması nedeniyle cerrahi gerekti. Altı hasta eksitus oldu. Bu hastaların üçünde eksitus nedeni kanama ile ilişkili idi. Sonuç: Dieulafoy lezyonu nadir fakat gastrointestinal kanamaların önemli bir sebebidir. Erken tanı ve uygun tedavi önemlidir. Tanı için tekrarlayan endoskopi gerekli olabilir. Hemoklip uygulaması skleroterapi ile veya skleroterapi olmaksızın ucuz, kolay, güvenli ve etkili bir tedavi yöntemidir.

Anahtar Kelimeler

• Dieulafoy lezyonu
• üst gastrointestinal kanama
• tedavi
• hemoklip

Retrospective analysis of patients with Dieulafoy’s lesions

Öz

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.

Anahtar Kelimeler

• Dieulafoy
• upper gastrointestinal bleeding
• hemoclip
• treatment

Kaynakça

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