HanoiA 32-year-old patient with rare Dieulafoy disease, causing gastrointestinal bleeding, risk of massive bleeding, was performed appendectomy in time.
Currently, after 2 weeks of surgery, the patient in Zhejiang, China re-examined with no signs of bleeding again. The patient recounted that due to bloody stools lasting 6 hours, he went to Hanoi Tam Anh General Hospital for emergency in mid-September. The patient had no other gastrointestinal symptoms. According to the test results, ultrasound, … the patient bleeds a lot from the appendix hole, the stool is mixed with blood estimated at 600-800 ml; acute anemia; Blood coagulation, liver and kidney function were normal. The doctor diagnosed the patient with Dieulafoy’s appendiceal lesion and indicated laparoscopic appendectomy.
Doctor, Dr. Vu Truong Khanh – Head of Gastroenterology – Hepatobiliary – Pancreas Department, Tam Anh General Hospital in Hanoi, said Dieulafoy’s lesion is a condition in which a submucosal artery is abnormally dilated and eroded. gastrointestinal mucosa. This is a dangerous disease that can lead to massive, life-threatening bleeding due to bleeding originating in the artery and difficult to locate the lesion. Appendiceal bleeding due to Dieulafoy’s lesion is rare.
According to an American study, Chicago published in the American Library of Medicine, this lesion accounts for about 1-2% of all causes of gastrointestinal bleeding and 6.5% of causes of upper gastrointestinal bleeding.
The cause of lower gastrointestinal bleeding may stem from pathology in the colon, rectum, and terminal ileum. Appendiceal bleeding may be due to vascular dysplasia or Dieulafoy’s lesion.
The patient was operated on in about an hour. The doctor followed up with no hematoma, no recurrence of black blood in the stool and discharged after 6 days.
Dr. Khanh added that this lesion often occurs suddenly, early warning clinical symptoms are often not clear. In most cases, the disease is discovered when the lining underneath the vessels has eroded, causing bleeding. At this time, most of the patients showed signs of black blood, anemia, vomiting, hemoptysis, rapid pulse, and low blood pressure. This injury to the gallbladder can cause abdominal pain.
Due to the sudden development, it is easy to be confused with other similar lesions such as arteriovenous malformations, hemangiomas, colonic ductal polyps, etc., so the disease is often missed when initially diagnosed. Treatment of gastrointestinal bleeding should be urgent, combining systemic treatment and local hemostasis.
The disease tends to occur in the elderly; have a history of cardiovascular disease, peptic ulcer, hypertension, diabetes, chronic kidney failure… This damage can be seen in children.
“Currently, gastrointestinal endoscopy is the ‘gold standard’ for diagnosing Dieulafoy lesions,” said Dr. Khanh. According to the study of Dieulafoy . lesions post above American Library of Medicine, hemostasis can be successfully achieved in about 80-85% of endoscopically treated cases. As a result, the mortality rate from gastrointestinal bleeding due to this injury was significantly reduced to 8.6%.
According to Dr. Khanh, endoscopic images can detect about 70% of cases. In which, 50-60% of cases are found to be in a state of serious bleeding such as jet or blood flow. 30% undetectable may be due to intermittent bleeding; small lesion size, located in mucosal folds; lesions obscured by food or profuse bleeding, no lesions were found. To diagnose gastrointestinal bleeding due to this lesion, the physician needs to perform multiple endoscopy.
When there are signs of bloody stools, patients need to be hospitalized for treatment at major medical centers. Patients can minimize their risk factors by avoiding the use of nonsteroidal anti-inflammatory drugs and alcohol. Patients need periodic follow-up with the gastroenterologist to monitor the condition and prevent recurrence.