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上消化道大出血是临床常见急症,及时确定病因对抢救处理极为重要.我们曾遇到4例少见原因上消化道大出血,现介绍如下.胃Dieulafoy氏溃疡大出血例1:女,67岁,突然呕血1天入院,查体,T 37.5℃,P124次/分,R20次/分,BP 11.5/7kPa,神态清,心、肺、腹未见异常.血Hb 72g/L,WBC 12×10~9/L,N 0.88,L 0.12.入院后急诊胃镜发现,胃体中段后壁邻近小弯侧见一线表溃疡0.8cm×0.8cm,中心见一暴露血管裂口.直径1mm,覆黑褐色血痂,即转外科手术,标本送病理检查报告,符合胃体Dieulafoy氏溃疡特征.讨论Dieulafoy氏溃疡约80%位于贲门口下4cm～6cm的胃体前、后壁近小弯侧,也有报道胃外病灶见于十二指肠(朱春兰,等.十二指肠球部 Dieulafoy样溃疡1例报告.内镜,1995,12(2):126).本病特点为突然反复发作的急性上消化道出血,以呕血为主,并无相关病史.急诊胃镜检查是诊断本病的首选方法,
Upper gastrointestinal bleeding is a common clinical emergency, timely determination of the cause of the rescue is extremely important.We have encountered 4 cases of rare causes of upper gastrointestinal bleeding, are described below.Gasula Dieulafoy’s ulcer hemorrhage cases 1: female, 67 years old, a sudden hematemesis One day admission, physical examination, T 37.5 ℃, P124 beats / min, R20 beats / min, BP 11.5 / 7kPa, no abnormal demeanor, heart, lungs and abdomen.Hb 72g / L, WBC 12 × 10 ~ 9 / L, N 0.88, L 0.12.After admission emergency gastroscopy found that the proximal wall of the proximal gastric wall see the first line ulcer 0.8cm × 0.8cm, the center of a exposed vascular opening diameter of 1mm, covered dark brown blood scab, That is surgery, specimens sent pathological examination report, in line with the characteristics of Gastric Dieulafoy’s ulcer.Discussion Dieulafoy’s ulcer about 80% located in the gastric cardia 4cm ~ 6cm before the body, the posterior wall near the lesser curvature side, there are also reports of gastric lesions Found in the duodenum (Zhu Chunlan, etc. Duodenal bulb Dieulafoy-like ulcers in 1 case report. Endoscopy, 1995,12 (2): 126). The disease is characterized by sudden recurrent acute upper gastrointestinal bleeding , Mainly to vomiting blood, no relevant medical history .Emergency gastroscopy is the preferred method of diagnosis of the disease,