Dieulafoy described cases of gastrointestinal hemorrhage associated with an abnormal submucosal gastric artery. This uncommon vascular malformation has been referred to as caliber persistent artery, exulceratoi simplex, and cirsoid aneurysm. Similar lesions may be found in other parts of the GI tract.


The artery is usually located on the upper part of the stomach, within 6 cm of the gastroesophageal junction, often along the lesser curvature. The histologic appearance of the arterial wall is normal.


Clinical presentation:

(1) recurrent episodes of massive upper GI hemorrhage with hematemesis

(2) often in middle aged males

(3) no symptoms of dyspepsia, anorexia or abdominal pain

(4) not associated with use of alcohol or NSAIDs

(5) often requires red blood cell transfusion (usually 3-8 units)



(1) may be normal

(2) may appear as a bleeding focus surrounded by normal gastric mucosa

(3) may appear as a mucosal defect with a protruding blood vessel

(4) often is negative for peptic ulcer, tumor or varix (if present, these lesions may initially be considered the source of bleeding)


Angiography is characteristic, especially when the lesion is actively bleeding.



(1) angiography

(2) endoscopic (banding, clipping, epinephrine injection, laser photocoagulation, electrocoagulation, injection sclerotherapy, others)

(3) laparoscopy


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