| Summary: | A 76 years old man came in our emergency department because<br />of two episodes of haematemesis. About your gastrointestinal<br />system, during the last gastroscopy, it was revealed gastric<br />atrophy, hernia of the esophageal hiatus and a light teleangectasia<br />in the posterior wall of the stomach. On admission, there was<br />severe anaemia (Hb = 4,7 g/dl). He was immediately transfused<br />with two units of blood (concentrated red cells) type 0 negative.<br />The subsequent gastroscopy revealed an haemorrage in the posterior<br />wall of the stomach as in the case of Dieulafoy’s lesion. It<br />was treated with an injection of epinephrine (1:10.000) during<br />the same gastroscopy. After numerous blood transfusions, the<br />course was good and he came back home with specific gastric<br />teraphy.<br />Dieulafoy’s lesion is an uncommon cause of gastrointestinal<br />bleeding (1-2%) with a prevalence in men (M:F = 2:1) and typical<br />of middle age (about 54 years). It is caused by a spontaneous<br />rupture of a submucosal gastric small artery but it may also<br />occur in esophagus, small intestine, colon and rectum. It seems in<br />relation with particular anatomic and physiologic conditions of<br />the artery involving in the process as: a large calibre, a tortuos<br />wall, continuous variations of blood pressure.<br />At the beginning, the most common symptoms are: haematemesis<br />and/or melaena, anaemia (8,4-9,2 g/dl). Diagnosis occurs<br />especially during gastroscopy (82-96% of the cases). In the other<br />cases, diagnosis occurs during laparotomy or with angiography.<br />The best choiche of the therapy is the injection of epinephrine<br />during gastroscopy (85%). In the other cases, teraphy is<br />based on electrocoagulation, sclerotherapy, laserteraphy, mechanical<br />“clipping”. The re-bleeding occurs in about 15% of the<br />cases. In this case, 5% of the patients needs of a complete surgical<br />intervention. Prognosis is better after the development of the<br />gastroscopy and endoscopic therapeutical techniques especially if<br />the cause of bleeding is diagnosed and treated immediately (free<br />survival time = 28-36 months).
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