| Popis: |
A 40-year-old man visited the hospital because of tarry stool. Endoscopic examination revealed coagula at the cardiac part of the stomach, but no clear source of bleeding was revealed. The patient was admitted under a diagnosis of upper gastrointestinal bleeding of unknown etiology. Because of anemia and sustained tarry stool, blood transfusion was performed. Despite repeated endoscopic examinations, the bleeding source was still unclear. We inferred that any conservative therapies had limits in treating this case, and emergency operation was carried out on the 15th hospital day. Intraoperative endoscopy revealed a small amount of bleeding in the cardiac side of the stomach, but no bleeding source could be confirmed. Additional intra-abdominal abnormalities were not found. As a result of ruling out probable diagnoses, Dieulfoy's ulcer with its bleeding source locating nearby the cardiac part was suspected. Total gastrectomy was performed. Macroscopic and microscopic examinations of the excised specimen showed that the bleeding site lay in a large blood vessel of 1.5 mm in diameter exposed from a microulcer of ULII, 1.5 mm in diameter, locating the anterior wall mean the greater curvature about 2 cm analside from the cardiac part of the stomach. A diagnosis of Dieulafoy's ulcer was made. Postoperative course was uneventful, and the patient was discharged on the 21st hospital day. A rare and valuable case of Dieulafoy's ulcer which could be diagnosed histopathologically is presented. |
