Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.
References
[1]
Ribeiro, A.M., da Silva, S., Reis, R.A., Romero, I., Costa, S. and da Silva, J.B. (2021) Dieulafoy’s Lesion in the Cecum: A Rare Case Report Presentation. International Journal of Surgery Case Reports, 84, 106157. https://doi.org/10.1016/j.ijscr.2021.106157
[2]
Baxter, M. and Aly, E.H. (2010) Dieulafoy’s Lesion: Current Trends in Diagnosis and Management. Annals of the Royal College of Surgeons of England, 92, 548-554. https://doi.org/10.1308/003588410X12699663905311
[3]
Joarder, A.I., Faruque, M.S., Nur-E-Elahi, M., Jahan, I., Siddiqui, O., Imdad, S., Islam, M.S., Ahmed, H.S. and Haque, M.A. (2014) Dieulafoy’s Lesion: An Overview. Mymensingh Medical Journal, 23, 186-194.
[4]
Malik, T.F. and Anjum, F. (2023) Dieulafoys Lesion Causing Gastrointestinal Bleeding. https://www.ncbi.nlm.nih.gov/books/NBK562267/
[5]
Martinez-Tapia, A., Duarte-Chavez, R., Mehta, S.V., Chaput, K.J. and Wey, B. (2019) 3144 Dieulafoy Lesions: A Rare Case of Recurrence. The American Journal of Gastroenterology, 114, S1689-S1690. https://doi.org/10.14309/01.ajg.0000602108.55260.a1
[6]
Santacoloma Osorio, M. and Camilo Giraldo, G. (2017) Manifestaciones gastrointestinales de la enfermedad renal crónica. RevistaColombiana de Nefrología, 4, 17-26. https://doi.org/10.22265/acnef.4.1.266
[7]
Cases, A. and Escolar, G. (1998) Sociedad Española de Nefrología. Nefrología, 18, 270-282.
[8]
Jutabha, R. and Jensen, D.M. (1996) Management of Upper Gastrointestinal Bleeding in the Patient with Chronicliver Disease. Medical Clinics of North America, 80, 1035-1068. https://doi.org/10.1016/S0025-7125(05)70479-X
[9]
García Agudo, R., Aoufi Rabih, S., González Carro, P., Pérez Roldán, F., Proy Vega, B., Arias Arias, Á., Cazalla Cadenas, F., Tenías Burillo, J.M. and Fernández Rodríguez, A. (2019) Lesiones gastrointestinales en pacientes con enfermedad renal crónica y anemia. Nefrología, 39, 50-57. https://doi.org/10.1016/j.nefro.2018.05.010
[10]
Jeon, H.K. and Kim, G.H. (2015) Endoscopic Management of Dieulafoy’s Lesion. Clinical Endoscopy, 48, 112-120. https://doi.org/10.5946/ce.2015.48.2.112