TWO CASES OF EXULCERATIO SIMPLEX (DIEULAFOY)

In the recent years, Dieulafoy's ulcer is clinically noted, and this paper describes two cases of Dieulafoy's ulcer or its analogue. Both cases presented with sudden hematemesis and melena. As bleeding could not be stopped by conservative treatments including endoscopic hemostasis, emergency operations, proximal gastrectomy in one having an ulcer in the lesser curvature just below cardia and conventional partial gastrectomy in the other having an ulcer in lower body, were carried out. The ulcers were both of shallow, small and acute type with less than 10 mm in major axis and could be differentiated into U1II. Moreover, in submucosal layer of the ulcer bases, arteries with outer diameters of 750μm and 1000μm respectively were recognized. It is common that Dieulafoy's ulcer is operated on with proximal or conventional partial gastrectomy which is used to be applied to peptic ulcers, and we also adopted it. However, when the severe bleeding in Dieulafoy's ulcer comes from the existence of the abnormal arteries in submucosal layer, proximal or conventional partial gastrecotmy may not be necessarily required and ligature and suture hemostasis or local wedge resection may be satisfactory.