만성 신부전 환자에서 위와 직장의 Dieulafoy양병변에 의한 위장관 출혈 1예 = A Case of Gastrointestinal Bleeding Caused by Dieulafoy-like Lesions of the Stomach and Rectum in a Patient with Chronic Renal Failure

다국어 초록 (Multilingual Abstract)

Dieulafoy's lesion is a very rare cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The majority of lesions are found in the stomach, but rarely it has also been identified in the duodenum, small bowel, colon and rectum. We describe a 78-year-old female with chronic renal failure who presented with melena and was subsequently found to have a Dieufaloy-like lesion in the stomach. The bleeding was successfully managed by endoscopic hemoclipping. During the follow-up, massive gastrointestinal bleeding was developed by a Dieulafoy-like lesion in the rectum. This lesion was managed by endoscopic band ligation, but there was recurrent bleeding from the ulcer site. The ulcer site was locally excised and primary closure was carried out.

국문 초록 (Abstract)

Dieulafoy 궤양은 작은 점막 병변 내로 노출된 혈관으로부터 심한 위장관 출혈을 일으키는 질환으로 대부분의 병변은 위의 상부에서 발견되지만 드물게 같은 병변이 십이지장, 소장, 대장에서도 관찰된다. 저자들은 흑색변을 주소로 내원한 만성 신부전을 동반한 78세 여자 환자에서 위에 Dieulafoy양 병변을 관찰하고 내시경적 hemoclipping을 시행하여 성공적으로 지혈하였다. 경과 관찰 중 직장에 발생한 Dieulafoy양 병변에서 대량의 위장관 출혈이 발생하여 내시경적 밴드결찰술로 초기 지혈에 성공하였으나 밴드가 탈락된 후 생긴 궤양에서 재출혈하여 궤양부위를 국소절제하고 일차봉합하여 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

참고문헌 (Reference)

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