Two Cases of Exulceratio Simplex Following Sclerotherapy for Esophageal Varices

Fukumasa Tsuji, Fumitoshi Kimura, Yoshisada Yamasaki, Yoichi Yamanaka*

Department of Surgery, Shiso Municipal Hospital
*Yamanaka Clinic

Exulceratio simplex (Es) is a rare disease that is characterized by the rupture of comparatively thick arteries in the bottom of a gastric ulcer, resulting in massive hemorrhage. We encountered two cases of Es which developed after endoscopic sclerotherapy for esophageal varices. The etiology of Es is discussed with reference to the literatures. Case 1: A 63-year-old man. The chief complaint was hematemesis. He had experienced hemorrhage from esophageal varices, and it recurred after sclerotherapy. Observation revealed blood gushing from a rupturd artery in the posterior wall directly below the EC junction. Case 2: A 53-year-old man. The chief complaint was general fatigue. He had undergone sclerotherapy for ruptured esophageal varices, but then a site of hemorrhage was seen on the posterior wall directly below the EC junction. The etiology of Es following sclerotherapy is assumed to be as follows: a thrombus forms in the left gastric artery due to the development of an arteriovenous shunt as a result of liver cirrhosis, the thrombus, in turn, causes a circulatory disorder, which leads to degeneration of the arterial wall and ulcer formation in the gastric mucosa, then the internal pressure in the left gastric artery becomes elevated due to (1) the increased blood flow in the left gastric artery caused by liver cirrhosis and (2) the increased vascular resistance in the left gastric artery caused by the thrombus.

Key words
endoscopic sclerotherapy, exulceratio simplex, esophageal varices

Reprint requests
Fukumasa Tsuji
2-11 Koyochonaka, Higashinada, Kobe, 658 JAPAN

Accepted
November 11, 1992

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