Exulceratio Simplex (Dieulafoy), Report of Four Cases and a Review of the Literature Koh Ikeda 1 , Teruyoshi Ishida 2 , Haruo Tateishi 3 , Hideaki Hanamiya 3 , Yoshito Ohwaki 3 1Ikeda Clinic 2Department of Thoracic Surgery, Kyushyu Cancer Center 3Department of Surgery, Aso Iizuka Hospital, Iizuka pp.999-1005
Published Date 1985/9/25
DOI https://doi.org/10.11477/mf.1403109798
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 Five lesions of exulceratio simplex (Dieulafoy) in four patients are reported. All of them were diagnosed by urgent endoscopy and survived by operation (partial gastrectomy in two cases, total gastrectomy and wedge resection in each one case). Regarding the nature of these lesions there were two schools of thought; that it is a miliary aneurysm due to acquired arteriosclerosis, or it is a congenital vascular malformation. Recent literature agrees with the latter theory. From Japanese references we collected 28 cases which were reported as“Dieulafoy”, and two cases of ruptured microaneurysm. Of the 34 patients including our cases, sex predominance was noted, with a male to female ratio of 4: 1. The age range was 11 to 80 years with an average of 57 (male) and 59 (female). Hematemesis was present in all except three cases and each had melena alone. The locations of these lesions except one unknown case have been recorded in the oral side from the middle corpus. Mean time from onset (hematemesis) to endoscopic diagnosis or surgical treatment was 5.7 days and so survival rate was 70.5%; mortality rate was 8.8% and unknown cases was 20.5%. It is important to know this entity and perform urgent panendoscopy for cases of unexplained gastrointestinal hemorrhage, especially hematemesis.

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