内視鏡的HS-E局注療法により止血に成功した胃のDieulafoy潰瘍の1例

Dieulafoy's Ulcer Cured by Endoscopic Local Injection of Hypertonic Saline Epinephrine Solution (HS-E), Report of a Case

要旨　5年前に胃潰瘍からの出血で入院したことのある51歳の男性が，仮性眩暈と黒色便で入院した．翌朝大量出血し，緊急内視鏡検査を実施したところ，胃角小彎より噴水状の出血があり，そこにHS-Eを局注し，止血に成功した．出血血管の周囲に潰瘍は認められずDieulafoy潰瘍と診断した．これまで，手術がDieulafoy潰瘍からの出血に対する唯一の治療手段と考えられてきたが，内視鏡的HS-E局注をDieulafoy潰瘍に対して試みる価値があると考えられる．

　A 51-year-old man with a previous history of bleeding gastric ulcer five years ago, was admitted to our hospital because of dizziness and melena. On the next morning he vomited large volume of blood. Urgent fiberoptic endoscopy was performed revealing a jet of blood from the lesser curvature of the gastric angle (Fig. 1). HS-E was immediately injected to the point of bleeding (Fig. 2) and was successful in stopping it (Fig. 3). No peptic ulcer was found around the exposed vessel. We therefore diagnosed this case as Dieulafoy's ulcer. It tends to be considered that an operation is the only treatment to stop bleeding from Dieulafoy's ulcer. However, endoscopic local injection of HS-E is worth trying in cases with bleeding Dieulafoy's ulcer.