内視鏡的止血後再出血を来したExulceratio simplex（Dieulafoy）の1手術例

Exulceratio Simplex (Dieulafoy), Report of a Case

要旨　患者は75歳，男性．突然の吐血を来し緊急内視鏡検査にて出血性の露出血管を認めたため内視鏡的に局注療法を行い，いったん止血しえた．内科的に治療を行う予定であったが，5日目に再出血し再び局注療法を行うも，再出血したため手術を行い，病理学的にExulceratio simplex（Dieulafoy）の診断を得た．本症例の病理学的所見から本疾患の病態，治療について述べる．

　A 75-year-old male was admitted to the hospital because of sudden onset of hematemesis causing preshock status.

　Emergency endoscopy revealed an exposed blood vessel resulting in oozing of blood in the upper corpus of the stomach (Fig. 1a). Endoscopic hemostasis was successfully made by local injection of hypersaline epinephrine solution at that time (Fig. 1b, c).

　On the 5th day after the treatment, the patient again developed bleeding (Fig. 2a) and fell into shock status despite of immediately tried endoscopic hemostasis (Fig. 2b, c) this time. Subsequently surgical treatment was performed on the same day. Histopathological study of the resected specimen showed a rupture of abnormally large artery in the submucosal layer, which formed the basis of our diagnosing Exulceratio simplex (Dieulafoy) (Figs. 3-6).

　To consider a possibility of Exulceratio simplex is important in the treatment of massive gastric bleeding.