A rare cause of upper gastrointestinal bleeding: Dieulafoy's disease [Seyrek gorulen bir ust gastrointestinal sistem kanama nedeni: Dieulafoy lezyonu]

Dieulafoy's disease is an arterial lesion with is frequent and serious bleeding and in new cases it is macroscopically protruding into the intestial lumen having clot on its surface. In our clinic, between 1994 and 1996, Dieulafoy's disease was identified in 12 (2.3%) of 515 patients followed by the diagnosis of upper gastrointestinal bleeding without having varices. The clinical features of these cases were retrospectively analyzed. There were 8 males and 4 females, average ages 59±18. The reasons for applying to the hospital were hematemesis and melena in all patients. Hemoglobin values were between 5 to 10 g/dL at the hospitalization and blood transfusion during follow-up in the clinic was between 3 to 10 units. Additional systemic disease was diagnosed in 8 patients. Endoscopicaly the lesion was at the proximal corpus in 8, fundus in 3 and cardia in 1 case. During endoscopy, active bleeding was observed in 7 cases and in 5 cases, a vessel having clot on its surface was identified. Endoscopic injection sclerotherapy (Adrenalin 1/10.000, polidocanol % 1) was the treatment in all cases. Bleeding recurred in 2 cases after initial sclerotherapy. In one of these two cases, bleeding could not be stopped even after second sclerotherapy and the patient died during surgery. Sclerotherapy is generally successful in the treatment of Dieulafoy's disease. The diagnosis of Dieulafoy's disease should be remembered in cases of frequently recurring hemorrhage having unidentified reason endoscopically