1993 Volume 35 Issue 2 Pages 304-308_1
A 60 year-old female, who had maintained by chronic hemodialysis for five years, was admitted to our hospital because of severe anemia. Upper gastrointestinal endoscopy before admission revealed bleeding hemorrhage in the gastric antrum. Follow-up endoscopy on admission showed longitudinal stripes consisted of many red spots in the distal part of the gastric antrum, and the endoscopic view of which resembled the stripes of a watermelon. In addition, hypermobility of the gastric antrum could be markedly confirmed by precise observation during endoscopy. The possibility of bleeding from the gastric antrum was suggested by angiography and RI scincigraphy. Other investigations, including barium examination through the small intestine and colonoscopy could not detect any other source of gastrointestinal bleeding. Because the gastrointestinal bleeding was uncontrolable and anemia progressed in spite of intensive medical therapy, she was surgically treated by gastric antrectomy and Billroth II anastomosis. Histological finding of the resected specimen revealed fibromuscular hyperplasia in the lamina propria, fibrin thrombi of the true capillaries, and dilated blood vessels in both the lamina propria and the submucosa. In consideration of these endoscopic and histologic findings, we diagnosed this case as antral vascular ectasia. In addition, the endoscopic observation of hypermobility in the gastric antrum may have played an important role on the pathogenesis of vascular ectasia in our case.
