Dieulafoy's Lesions Treated by Gastrectomy and Endoscopic Bipolar Electrocoagulation, Report of Seven Cases Kiyoshi Hajiro 1 , Daijiro Tsujimura 1 , Hirokatsu Matsui 1 , Mikio Shiomi 1 , Hideyuki Abe 1 1The Second Department of Internal Medicine, Kinki University School of Medicine pp.1182-1186
Published Date 1987/10/25
DOI https://doi.org/10.11477/mf.1403112958
  • Abstract
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 Solitary gastric erosive lesions of Dieulafoy have been increasingly recognized by endoscopy. Two surgically treated cases in 1977 and 5 cases treated by endoscopic bipolar electrocoagulation (BPEC) that we deveioped in 1980 are described. Development of effective endoscopic hemostatic methods has modified the definition of Dieulafoy's ulcers, since the caliber of submucosal arteries cannot be measured and their endoscopic appearances resemble solitary stress or druginduced acute erosions in the gastric body.

 Case 1 (Figs. 1-3) : A 47-year-old man who presented with melena had a solitary bleeding lesion in the mid-body. Spurting bleeding from an artery was recognized during the repeat endoscopy performed with the intention of monopolar electrocoagulation. Hypovolemic shock developed requiring 2,000 ml blood transfusions and he was immediately transferred for an operation. A ruptured artery was noted at the bleeding erosive lesion. The postoperative course was uneventful with no recurrence of bleeding.

 Case 2 (Figs. 4 and 5) : A 33-year-old man who felt palpitation the day before suddenly vomited a total of 1,500 ml fresh blood while waiting and being examined in a clinic. The systolic blood pressure was 84 mm Hg, Hgb and Hct being 5.9 g/dl and 17.9% respectively. Endoscopic examination performed after 3,200 ml blood transfusion showed seeping blood from one of the three erosive lesions in the body. Subsequently, proximal gastrectomy was carried out. A ruptured submucosal artery was noted in the erosive lesion.

 Case 3 (Fig. 6 b, Table 1) : A 55-year-old woman was noted to have bleeding from a visible vessel at endoscopy and treated successfully by BPEC.

 Case 4 (Fig. 7, Table 1) : A 12-year-old girl who was successfully treated by BPEC bled massively again 6 years later, when another BPEC stopped a spurting bleeding in the fornix.

 Clinical data of BPEC-treated cases are summarized in Table 1.

Copyright © 1987, Igaku-Shoin Ltd. All rights reserved.


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