12th Ljudevit Jurak
International Symposium on
June 1-2, 2001
|DIEULAFOY‘S DISEASE VASCULAR MALFORMATION
IN THE GASTRIC WALL - A CASE REPORT
|M. Tolovska, S. Kostadinova
Institute of Pathology, Faculty of Medicine, Skopje, Macedonia
|Dieulafoy‘s disease is a vascular malformation of the gastric wall
with abnormally dilated and tortuous arteries which are present in the
submucous layer of the gastric wall and may penetrate the mucose. The disease
is most frequently manifested as gastrointestinal bleeding, the reason
for which usually remains unknown after endoscopy.
Materials and methods: At the Institute of Pathology, Faculty
of Medicine in Skopje, the third case of Dieulafoy‘s disease has been diagnosed
in a 50-year-old patient. The previous two cases were verified in operative
materials, and one of them was also confirmed during an autopsy. For this
case, 2/3 resection of the gaster was obtained with clinical diagnosis
of haemorrhagic ulcer, but an ulcerative lesion was not found the macroscopic
examination. The mucose showed a small zone of haemorrhage with a suture.
Tissue sections taken for the histological examination were routinely embedded
in paraffin, stained with HeEo, and also with the histochemical staining
methods for Van Gieson and orcein elastica.
Results: The definite diagnosis of the disease was made upon
the histological analysis of the taken tissue sections. The mucose was
completely intact, with haemorrhage in the lamina propria. The basic process
was found in the submucose layer where abnormally dilated and tortuous
arteries with thick walls and hypertrophied musculature were seen
a finding which corresponds to the Dieulafoy‘s disease. The superficial
segments of the arteries were thrombosed, which indicated recent haemorrhaging.
The above described changes were followed with a phlegmonous type of acute
gastritis, which spread through the layers of the gastric wall and reaching
Conclusion: Since Dieulafoy‘s vascular malformation is almost
always manifested with gastrointestinal bleeding and requires urgent surgical
treatment; it is essential to have this unusual and rare disease in mind.