Novosti
Khirurgii

DOI: https://dx.doi.org/10.18484/2305-0047.2022.6.592   |  

A.I. PANASYUK ¹, E.G. GRIGORYEV ^{1, 2}

RECURRENT GASTROINTESTINAL BLEEDING FROM DIEULAFOY’S LESIONS IN A PATIENT WITH VON WILLEBRAND DISEASE

Irkutsk State Medical University ¹,
Irkutsk Scientific Centre of Surgery and Traumatology ², Irkutsk,
Russian Federaration

The authors report the case of recurrent anematizing digestive bleeding in a 58-year-old woman who suffered from von Willebrand disease (VWD) and factor VIII deficiency. The hemorrhagic syndrome arose from a vascular malformation of the jejunum wall – Dieulafoy’s Lesions, a relatively rare pathology of the gastrointestinal tract, associated with high lethality. Convoluted arteries without signs of vasculitis were the contributor of hemorrhage. It is not improbable that Dieulafoy’s Lesions is a congenital malformation, since it develops in patients aged from 20 weeks to 94 years. Ulcers of the posterior wall of the upper third of the stomach was described. .. Such ulcers, located distal to the duodenojejunal junction, occur in no more than 1% of case reports. Intraluminal capsule and/or two-balloon jejunoscopy provides detection of the hemorrhage origin and localization. In the reported case, a bleeding vessel was found by means of selective contrasting of the upper mesenteric artery, which detected extravasation into the lumen of the first jejunum loop. Endovascular occlusion was technically impossible. After laparotomy esophagogastroduodenoscopy with manual intraabdominal assistance was performed. Two defects of the mucous membrane closed by a red blood clot appeared in 39-35 cm from the ligament of Treitz. Intestinal resection was performed in 2/3 according to A.V. Melnikov. Histological examination verified the diagnosis. In the presented case report, complex hematological pathology complicated the disease course. Intensive replacement therapy allowed bringing the VIII and von Willebrand factors to normal levels. In consequence, the surgical intervention without excessive bleeding.was performed.

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