A REVIEW OF 13 CASES OF SURGICALLY TREATED EXULCERATIO SIMPLEX (DIEULAFOY'S ULCER)

Abstract

No consensus exists on the etiology and diagnostic criteria for Dieulafoy's ulcer. To clarify the characteristics of this disease, clinical and pathological evaluation was made on 13 cases treated surgically in Tokushima Municipal Hospital. It was most frequently found in the upper gastric body (6 patients), while multiple ulcers were found in six cases. The depth of ulceration was UL-II in seven and UL-III in six cases. The ulcerations measured from 3×5 mm to 10×25 mm, with the diameter of the exposed vessels ranging from 1.0 mm to 2.5 mm.In all cases examined, the exposed vessels run without changing their diameters even after penetrating through the muscular layers, but ruptured after reaching the submucosa. None, however, showed arteritis or aneurysm, and only mild arteriosclerosis was found in one patient. One possible etiology is that the fortuitous occurrence of ulceration over an unusually large submucosal artery may cause it to rupture.In making the diagnosis of this disease, attention should be paid to abnormal running of large arteries. It is important to confirm hemorrhagic sites by gastrotomy during surgery. In postoperative period, it is necessary to follow the patients closely keeping in mind the possible recurrence of gastric hemorrhage. In addition to this cases, 107 others reported in Japan were reviewed for clinical evaluation.