Acute Massive Hemorrhage due to Exulceratio Simplex (Dieulafoy) and Gastritis

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Acute massive hemorrhage from the upper alimentary tract is usually caused by gastric or duodenal ulcer, gastric cancer, esophageal varices, and Mallory Weiss syndrome. The author has treated 93 cases of acute massive hemorrhage caused by gastric and duodenal diseases. They include one case of Exulceratio simplex (Dieulafoy) and 17 cases of gastritis. These two conditions are relatively rare cause of acute massive hemorrhage and must be treated in different approaches.Exulceratio simplex (Dieulafoy), reported by Dieulafoy in 1897, is characterized by a rupture of the varix in gastric wall. The varix is commonly located at the upper part of the stomach and unable to be detected by a palpation of the stomach. Therefore, blind gastrectomy is not effective and could rather be lethal surgery for this disease. The most resonable treatment is to open the stomach, and ligate the bleeding vessel or excise the bleeding area.Massive hemorrhage by gastritis is more common, and characterized by desquamation of the epithelium of gastric mucosa which is accompanied by acute catarrhal inflammation and reactive hyperemia. The mechanism of the bleeding would be supposed a capillary bleeding from the desquamated area. As the treatment of this disease, the author recommends partial blind gastrectomy of the antrum. All of the 17 cases were completely healed by this treatment.
財団法人日本消化器病学会の論文