IN the management of massive gastrointestinal tract bleeding the surgeon must be aware of the rarer causes in order to recognize and treat them appropriately. In 1897 simple mucosal erosion extending no deeper than the mucosa of the muscularis mucosa was described by Dieulafoy1 as one of these rare causes of severe upper-gastrointestinal tract bleeding. The bleeding site is never recognized from inspection of the outside of the stomach. The lesion is located in the body or fundus of the stomach within normal rugae and can only be found by wide gastrotomy and careful search. This knowledge is important for correct treatment. Simple ligation of the bleeding point is all that is required to control the hemorrhage, and gastrectomy is unnecessary. Blind gastrectomy can then be avoided.
Report of Cases
Case 1.—A 20-month-old white boy was admitted to the University of Iowa Hospitals on Aug 30, 1966, in a