Total gastrectomy in the surgical treatment of massive upper

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 exsanguinations makes it essential that both endosopical and surgical approach play an important role in the management of this pathology. Dieulafoy lezija predstavlja redak, ali znacajan izvor gastrointestinalnog krvarenja, koje potencijalno ugrozava zivot pacijenta. Procenjuje se da uzrokuje 3-4% svih hemoragija iz gornjeg dela gastrointestinalnog trakta (GIT). Krvarenje nastaje iz abnormalne, velike i erodirane submukozne arterije, udruzene sa minimalnim mukoznim defektom. Lezija je najcesce lokalizovana u proksimalnom delu zeluca. Pacijent star 42 godine upucen je u nasu ustanovu iz regionalnog Zdravstvenog centra sa znacima krvarenja iz proksimalnih partija GIT-a. U prethodna 24 sata pre prijema u nasu ustanovu imao je 14 melena i primio je 10 jedinica krvi i 11 jedinica sveze smrznute plazme. Po prijemu u nasu ustanovu postavljena je endoskopska dijagnoza Mallory-Weis sindroma i gastricnog subkardijalnog ulkusa. Nakon inicijalnog konzervativnog tretmana pacijent je hemodinamski stabilizovan a krvarenje sanirano. 48 sati nakon prijema dolazi do ponovljene masivne hemoragije pracene