THE POSSIBILITIES OF MINIMALLY INVASIVE TECHNOLOGIES IN COMPLEX TREATMENT OF PATIENTS WITH RECURRENT BLEEDING FROM ULCERS DIEULAFOY

An ulcer or Dielafua disease is a rare disease that manifests itself through an anomaly of the vessels of the submucosal layer of the stomach and the formation of an acute ulcer with profiled bleeding from an unusually large artery of artery artery. Typical for this disease are repeated relapses of bleeding, the treatment of which is one of the current and unresolved problems in clinical practice. The article demonstrates two clinical cases of treatment of patients with recurrent bleeding from Dielafua ulcer, who used a complex of endoscopic, endovascular methods of hemostasis in combination with open surgery. In the first clinical observation a patient with Dieloafua ulcer on the background of liver cirrhosis of portal hypertension syndrome is presented. Due to repeated recurrence of hemorrhage, the patient used a combined endoscopic hemostasis (injection, clipping, argon-plasma coagulation), laparotomy, gastrotomia, suturing of the Dieloafua ulcer of the stomach floor. However, the final hemostasis was achieved by endovascular method. Super-selective embolization of the bleeding source, the branches of the left gastric artery, was performed.In the second clinical observation in a patient with multiple recurrences of bleeding from Dieloafuan ulcer against the background of combined endoscopic hemostasis and impossibility of selective embolization due to the risk of spleen infarction, a laparotomy was performed, complete devascularization of the abdominal section of the esophagus and stomach by large and small curvature with preservation of the right gastric artery.The possibilities of minimally invasive technologies in complex treatment of patients with recurrent bleeding from Dielafua ulcer are shown on clinical examples.

gastric bleeding, recurrent bleeding, endoscopic hemostasis, endovascular embolism, Dielafua ulcer