title: [Total gastrectomy in the surgical treatment of acute massive hemorrhage caused by Dieulafoy lesion of the gastric fundus].
abstract: GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a rare cause of massive gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. We report a case of an 42-year-old man presented with upper GI hemorrhage. Repeated upper GI endoscopies revealed a missed diagnosis of subcardial gastric ulcer and Mallory-Weis lesion. Following conservative treatment, the frequency and amount of haemorrhage decreased and totally stop. 48 hours after admission patient developed sudden massive upper GI bleeding and underwent emergency total gastrectomy. The diagnosis of Dieulafoy lesion was made histologically. The patient recovered uneventfully and discharged on the postoperative day 11th. Therefore, Dieulafoy disease represent a diagnostic and therapeutic challenge. Advances in endoscopic technique have greatly assisted in earlier diagnosis and added options to the treatment regimen for this lesion. The relationship of this anomaly to possible exsanguination makes it essential that both endosopical and surgical approach play an important role in the management of this pathology.
authors.affiliation: Centar za urgentnu hirurgiju, KCS, Beograd.
authors.forename: A R
authors.initials: AR
authors.lastname: Karamarković
authors.forename: P B
authors.initials: PB
authors.lastname: Gregoric
authors.forename: N M
authors.initials: NM
authors.lastname: Popović
authors.forename: N N
authors.initials: NN
authors.lastname: Ivancević
authors.forename: V M
authors.initials: VM
authors.lastname: Bumbasirević
authors.forename: A M
authors.initials: AM
authors.lastname: Sijacki
authors.forename: Z
authors.initials: Z
authors.lastname: Lausević
authors.forename: Dj D
authors.initials: DjD
authors.lastname: Bajec
authors.forename: V R
authors.initials: VR
authors.lastname: Djukić
authors.forename: V M
authors.initials: VM
authors.lastname: Jeremić
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D005743:Gastrectomy; D005748:Gastric Fundus / Q000098:blood supply*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male