[Bleeding from Dieulafoy's ulcer after argon-plasma laser coagulation of gastric angiodysplasia in Heyde's syndrome].

HISTORY: A 75-year-old, pale-looking man with known severe valvar aortic stenosis and three-vessel coronary artery disease previously treated with two bypass grafts was referred for elucidation of anaemia before further coronary artery surgery.

INVESTIGATIONS: In addition to chronic iron-deficiency anaemia (haemoglobin 9.5 g/dl) endoscopy revealed gastric angiodysplasia. Endoscopy of the colon was negative.

DIAGNOSIS, TREATMENT AND COURSE: Argon-plasma laser coagulation (APC) for the angiodysplasia was performed twice. Although there were no complications at first, five days later tarry stools were noted and hypovolaemic shock developed. Emergency gastroscopy revealed a bleeding vessel stump (Dieufaloy's lesion) proximal to the APC-induced ulcer (stage Ib bleeding [Forrest's classification]). Epinephrine and fibrin glue were applied endoscopically. The patients died 20 days later of septicaemic and multiorgan failure, the result of left-heart failure with pneumonia.

CONCLUSION

APC, usually described as being a low-risk procedure, can cause mucosal damage resulting in Dieulafoy's lesion. APC should therefore be carefully monitored.