TITLE:
Uremic Bleeding in 2 Patients with Dieulafoy’s Lesion: Case Report and Literature Review
AUTHORS:
Gustavo Adolfo Hernández Valdez, Diana Estefanía Ibarra García, Juan Antonio Contreras Escamilla, Janette Alejandra Gamiño Gutierrez, Francisco Manuel Tonatiuh Carrillo Beltran, Ulises Solis Gomez, Jocelyn Nataly Quintero Meléndez, Ivan Alejandro Medina Jimenez, Marco Antonio González Villar, Jorge Rojas Morales
KEYWORDS:
Dieulafoy’s Lesion, Gastrointestinal Bleeding, Endoscopy, Endoscopy, Hemostatic Clips, Kidney Disease, Adrenaline, Thermal Coagulation, Dieulafoy
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.14 No.5,
May
27,
2024
ABSTRACT: 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.