It has also been suggested that a congenital or acquired vascular malformation might be the underlying cause [25, 26]. Histologically, the eroded artery appears normal. There is no evidence of any mucosal inflammatory process, signs of deep ulcerations, penetration of the muscularis propria, vasculitis, aneurysm formation, or arteriosclerosis [6, 27, 28]. Patients with lesions in the duodenal bulb and proximal jejunum, present in a similar way to those with gastric lesions. Patients with lesions in the middle or distal jejunum, right selleck products colon and rectum present

with massive rectal bleeding [29, 30]. The risk of re-bleeding after endoscopic therapy remains high (9 to 40 percent in various reports) due to the large size of the underlying artery [31, 32]. The mortality rate for Dieulafoy’s was much higher before the era of endoscopy, where open surgery was the only treatment JPH203 manufacturer option [33, 34]. Hence vascular diseases of GIT are a known but rare cause of upper or lower

GIT bleeds. It may present as a diagnostic challenge because of its diverse manifestations, however, a physician should always consider vascular diseases as a cause of recurrent unexplained GI bleed [35]. Management of AVM may warrant major surgical undertaking both in elective as well as in emergency situation [[4, 16], and [35]]. Our patient had a diffuse type of AV malformation involving whole of the stomach as well as spleen which is an unusual occurrence. Attempt to diagnose by endoscopy lead to massive bleeding causing severe haemodynamic instability requiring emergency exploratory laparotomy and total gastrectomy with spleenectomy. AVM are more and more treated by endoscopic and endovascular techniques during the last twenty years but surgery remain a major rescue tool in emergency and treatment option in elective situations. Consent Written informed consent was

obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. References 1. Gough Cytidine deaminase MH: Submucosal arterial malformation of the stomach as the probable cause of recurrent severe haematemesis in a 16 year old girl. Br J Surg 1977, 64:522–4.CrossRefPubMed 2. Finkel LJ, Schwartz IS: Fatal haemorrhage from a gastric cirsoid aneurysm. Hum Pathol 1985, 16:422–4.CrossRef 3. Chapman I, Lapi N: A rare cause of gastric haemorrhage. Arch Intern Med 1963, 112:101–5. 4. Lefkovitz Z, Cappell MS, Kaplan M, Mitty H, Gerard P: selleck screening library Radiology in the diagnosis and therapy of gastrointestinal bleeding. Gastroenterology Clinics of North America 2000, 29:489–512.CrossRefPubMed 5. Goldman RL: Submucosal arterial malformation (‘aneurysm’) of the stomach with fatal haemorrhage. Gastroenterol 1964, 46:589–94. 6.