English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

cause she had been passing tarry stools for 2 days. Emergency endoscopy re− vealed an actively spurting Dieulafoy le− sion in the gastric fundus (l" Fig. 1). Be− cause of the technical difficulty of apply− ing hemoclips in this case we performed rubber−band ligation, which resulted in immediate hemostasis (l" Fig. 2). Twelve hours later, fresh blood reappeared in the nasogastric aspirate. A repeat endoscopy showed active oozing from the base of the ligated area (l" Fig. 3). Despite the in− jection of 12 mL of diluted epinephrine, the bleeding persisted. After discussing the situation with the patient she agreed to receive a sclerosant injection, and the bleeding stopped after an injection of a mixture of 0.5 mL of N−butyl−2−cyano− acrylate and lipiodol. The patient com− plained of dull epigastric pain after the injection, and a chest radiograph showed radiopaque material along the left dia− phragm (l" Fig. 4). Abdominal computed tomography confirmed that there was ex− travasation of sclerosant along the left subphrenic area (l" Fig. 5). The patient was free of any signs of infection and was discharged on day 6 of her hospital day. She remained well over the following 2 years. Endoscopic therapy is now a mainstay of treatment for Dieulafoy lesions. Several authors have documented hemostasis rates for endoscopic band ligation of 80 % ±100 % in case series of patients with Dieulafoy lesions [1, 2]. However, the optimal rescue therapy after failed endoscopic band ligation is not known. In the present case, injection therapy with diluted epinephrine failed to control the bleeding. Hemoclipping or coagulati− on therapy would have been technically difficult. It was believed that repeated band ligation would increase the risk of gastric perforation [3], and so Histoacryl injection was chosen as the last resort be− fore surgery [4]. Despite the successful hemostasis, the complication of injec− tion−site leakage and resultant transient abdominal pain are concerning. This might have been caused by direct pene− tration of the gastric wall by the injection needle. The short−term outcome of scler− osant extravasation in this case and in an− other reported case [5] was good, but it is still not clear what the long−term effects of this complication are.

Extravasation of sclerosant after injection of N-butyl-2-cyanoacrylate for a bleeding gastric Dieulafoy lesion