A CASE OF DOUBLE DIEULAFOY'S ULCER CURED BY ENDOSCOPIC LOCAL INJECTION OF HYPERTONIC SALINE EPINEPHRINE SOLUTION

Abstract

A 54-year-old man was admitted to our hospital with complants of hematomesis and melena. Emergency endoscopy revealed an exposed vessel without definite ulcers at the fornix of the stomach. Endoscopic hemostasis was successfully made by local injection of hypertonic saline epinephrine solution (HS-E method) at that time. However massive rebleeding occured becoming shock on the 4th day of admission. Emergency endoscopic findings showed no bleeding from the previous lesion at the fornix, but oozing of fresh blood from an exposed vessel at the angle was visualized. Endoscopic hemostasis was successfully done by HS-E method again. On the following day endoscopic findings revealed no definite ulcer at the angle. Therefore our diagnosis in this case was double lesions of Dieulafoy's ulcer of the stomach. Dieulafoy's ulcer is known as a relatively rare disease. Moreover a case of double Dieulafoy's ulcer is extremely rare. We considered endoscopic local injection of HS-E in an effective therapeutic method for patients with Dieulaf oy's ulcer.