Zusammenfassung
Das Ulcus Dieulafoy wurde 1896 vom französischen Arzt Georges D. Dieulafoy als Gefäßveränderung
im Magen mit der Folge schwerer gastraler Blutungen beschrieben. Die Läsion findet
sich zwar in den meisten Fällen im Magen, kann jedoch im gesamten Gastrointestinaltrakt
vorkommen. Eine Geschlechts- oder Altersprädilektion besteht nicht. Die Diagnose wird
endoskopisch gestellt, endoskopisches Hämoclipping gilt derzeit als therapeutische
Methode der Wahl. Nur in den wenigsten Fällen erfolgt eine Bestätigung der Diagnose
durch Histologie. Wir berichten über eine ältere Patientin, die während des stationären
Aufenthaltes wegen eines Bandscheibenvorfalls mehrmals blutigen Stuhlgang absetzte.
Endoskopisch ergab sich der Verdacht auf eine Blutungsquelle im rechten Hemikolon.
Auf eine erneute lebensbedrohliche Blutung mit starkem Abfall des Hb-Wertes hin erfolgte
die chirurgische Intervention mit Hemikolektomie rechts. Histologisch fand sich im
Colon ascendens als Blutungsquelle eine 350 µm im Durchmesser große, kaliberpersistente
submuköse Arterie mit geschlängeltem Verlauf und apikaler Ruptur.
Abstract
Dieulafoy’s lesion was described in 1896 by the French pathologist Georges D. Dieulafoy
as a vascular malformation in the stomach. Although usually found in the stomach,
the lesion may occur anywhere within the gastrointestinal tract and can cause severe
hemorrhage. There is no sex or age predilection. The diagnosis is established endoscopically,
and the current therapy of choice is endoscopic hemoclipping. Only rarely is the diagnosis
confirmed histologically. We report the case of an elderly female patient who, while
hospitalised for a slipped intervertebral disc, presented with lower gastrointestinal
bleeding. The source of the bleeding was suspected to be in the right colon by endoscopy.
Renewed massive bleeding necessitated surgical treatment with resection of the right
hemicolon. The histological work-up of the resected specimen identified a 350-micron
large tortuous submucosal artery that had eroded.
Schlüsselwörter
Ulcus Dieulafoy - Kolon - Histologie
Key words
Dieulafoy lesion - ulcer - colon - histology
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Dr. med. Corinna Vogel
Institut für Pathologie, Klinikum Bayreuth GmbH
Preuschwitzer Str. 101
95445 Bayreuth
Email: pathologie.klinikum-bayreuth@t-online.de
