Dieulafoy's disease associated with early gastric cancer

초록

Dieulafoy's disease of the stomach variously termed "caliber persistent artery" "aneurysm" "submucous arterial malformation" and "gastric arteriosclerosis" tends to affect middle-aged and elderly men without any past medical history. The disorder was thought originally to be related to an acquired aneurysm of an atherosclerotic abnormal vessel. Recently, it has been interpreted as a congenital anomaly characterized by a single large, tourtous, and caliber persistent submucosal artery with no evidence of vasculitis, atherosclerosis, or aneurysm formation. The disorder presents as recurrent, massive and often fatal hematemesis with an overall mortality rate of 60.5%. The cause of bleeding is believed to be a mucosal erosion resulting from an artery protruding into the overlying mucosa or from focal gastritis, leading to exposure of the vessel. Since this disease was first described by Gallard in 1884, many cases have been reported. However, Dieulafoy's diseases associated with other gastric malignancy were rarely described in the literature. We report a case of a Dieulafoy's disease associated with an early gastric adenocarcinoma presented as a massive hematemesis. A 65 year old man was admitted to our hospital with symptoms of hematemesis. Tere was no relevant family history, or excessive alcohol or aspirin intake. At admission, he was found to have a hemoglobin of 7.6g/dL, a red cell count of 2.37x10 6/uL, a hematocrit of 22.4%, a mean corpuscular colume of 9.4fL, and a platelet count of 149x103mL. An urgent upper GI endoscopy revealed a shallow ulcer with exposed vessel on the posterior wall of upper gastric body. Although injection therapy with 10mL of epinephrine (1:10,000) into the exposed vessel on the ulcer was tried, recurrent bleeding was found. Biopsies from this shallow ulcerated lesion confirmed the diagnosis of well differentiated adenocarcinoma of the stomach. There was no vascular abnormality in the biopsied gastric mucosa. Radical total gastrectomy sp