Hemorrhage from a Dieulafoy Type Ulcer of the Jejunum -Report of a Case-

Masayoshi Nishina, Chiiho Fujii, Akinori Ueda, Yasumasa Kajihara*, Mitsuyoshi Hirokawa**

Department of Emergency and Critical Care Medicine, Kawasaki Medical School
*Department of Radiology, Kawasaki Medical School
**Department of Patholgy, Kawasaki Medical School

Recently, owing to progress in endoscopy, the number of reported cases of gastric ulcer of Dieulafoy type has increased. However, this ulcer is very rarely reported in other locations. We encountered a paient wih hemorrhage from a ulcer of Dieulafoy tye of the jejunum which was treated surgically. A 68-year-old man was admitted to our hospital becourse of a cerebral infarct and received conservative treatment and rehabilitation. A large volume of tarry stool was suddenly discharged and he was transferred to the emergency department. The systolic blood pressure was 70 mmHg and the pulse rate was 108 per minute. The hematocrit value was 17.6%. No cause for the hemorrhage was found in the upper gastrointestinal tract. Scintigraphhy (^99mTc-RBC) was performed and accumlation was noted in the left eigastric region. Accordingly, angiography of the superior mesenteric artery was performed, and extravasation in the jejunum was noted. An emergency operation was carried uot, and about 15 cm of the jejunum was excised. On opening it, a small exposed vessel was seen. There was no ulcers or other abnormal findings, and rupture of a persistent caliber artery was diagnosed histologically. Only two cases of Dieulafoy type ulcer in the small intestine have been reported, by Matuchansky, as for as we know.

Key words
Dieulafoy type ulcer, jejunal bleeding, gastrointestinal hemorrhage

Reprint requests
Masayoshi Nishina Department of Emergency and Critical Care Medicine, Kawasaki Medical School
577 Mastushima, Kurashiki, 701-01 JAPAN

Accepted
May 9, 1990

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