**10. References**


**Part 5** 

**Gastrointestinal Bleeding** 


**Part 5** 

**Gastrointestinal Bleeding** 

252 Gastrointestinal Endoscopy

[3] De Angelis GL, Bizzarri B, De Angelis N, Borrelli O: The endoscopic diagnosis. In:

[4] Venkatesh K, Thomson M. Endoscopic Modalities in Pediatric Inflammatory Bowel

[5] Venkatesh K, Thomson M. Endoscopic Modalities in Pediatric Inflammatory Bowel

[6] Guariso G, Gasparetto M, Visonà Dalla Pozza L, D'Incà R, Zancan L, Sturniolo G, Brotto

[7] Boyle JT. Esophagogastroduodenoscopy in the pediatric patient. In: Gastroenterologic

[8] Mougenot JF, Bontems P, Cadranel S. Endoscopic Equipment. In: Pediatric

[10] Miele E: Pouchitis. In: SIGENP Consensus Statement (Italian Society of

[11] Stienecker K, Gleichmann D, Neumayer U, Joachim Glaser H, Tonus Long V. Term

[12] De Angelis GL, Bizzarri B, Vincenti F: Video capsule endoscopy. In: SIGENP Consensus

[13] Seidman SG, Dirks MH: Wireless Capsule Endoscopy in IBD: State of The Art and

[14] Mescoli C, Rugge M. Histology in Inflammatory Bowel Disease. In: SIGENP Consensus

[15] Dirks MH, Costea F, Sant'Anna, Peretti N, Seidman EG: Videocapsule Endoscopy in

[16] Role of the Wireless Capsule Endoscopy in Diagnosis of Undetermined Colitis and

Baldassano RN eds Springer Publ New York 2008, pp 211-35.

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Baldassano RN eds Springer Publ New York 2008, pp 275-87.

paediatric age. Eds Area Pediatrica Publ Milan Italy 2008, pp 27-30.

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SIGENP Consensus Statement (Italian Society of Gastroenterology Hepatology and Nutrition): Inflammatory Bowel Disease in the paediatric age. Eds Area Pediatrica

Disease. In: Pediatric Inflammatory Bowel Diseases. Mamula P, Markowitz JE,

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F, Facchin P. Inflammatory bowel disease developing in paediatric and adult age. *J* 

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Suspect IBD in Paediatric Patients. *Journal of Pediatric Gastroenterology and Nutrition* 

**18** 

*Turkey* 

**Rare and Emergency Gastric** 

**Bleeding Cause – Dieulafoy's Lesion** 

*1Yeditepe University Hospital, Department of General Surgery, Istanbul, 2Yeditepe University Hospital, Department of Emergency Medicine, Istanbul* 

Baki Ekçi1, Can Aktas2, Sezgin Sarikaya2, Asli Cetin Celik2 and Didem Ay2

Gastrointestinal bleeding is among the most common causes of emergency admissions. Having high mortality rates, high diagnosis and treatment costs, this condition constitutes a clinical problem that requires a multidisciplinary approach. Extra-varicose bleeding of the upper gastrointestinal system has still been frequent and it usually stops spontaneously. However, recurrent bleeding is the most important cause of mortality and morbidity.

Any remarkable cause could not be demonstrated in approximately 4-9% of massive upper gastrointestinal hemorrhage. (Cotton et al., 1973; Palmer, 1969). Bleeding and anemia might be associated with gastrointestinal vascular malformations. Some epidemiological studies suggest that symptomatic vascular anomalies may be present in approximately 1/10000 individuals (Hodgson et al., 2001). Dieulafoy's lesion is a rarely found vascular malformation in symptomatic vascular anomalies group of disease. It is commonly located in the proximal aspect of the stomach. Dieulafoy's lesion constitutes 1% to 5.8% of nonvariceal bleeds and is more common in men than in women (2:1) (Garg, 2007). Pathogenesis is still unknown, but it is assumed that it might be a congenital lesion (Regula et al.,2008). The typical lesion is generally located in the submucosa and described as a large tortuous vessel and a small defect in the overlying mucosal surface (Ekci et al., 2010; Vats et al., 2006). (Fig 1 & 2 & 3). In 1884, Gallard first described this lesion, but it was attributed to a French surgeon Dieulafoy in literature (Alva et al., 2006). This medical condition usually presents with a large tortuous arteriole in the stomach wall that erodes and bleeds. In addition, this lesion is generally located at the lesser curvature of the stomach within 6 to 10 cm of the esophagogastric junction (Stojakov et al., 2007). It consists of a single large tortuous arteriole that does not exert normal branching or has a branch 1–5 mm in diameter(Fig 2 & 3). This size is more than the normal diameter of mucosal capillaries. The most common location of the lesion is the body of stomach, followed by the cardia and the esophagus, but they have also been reported in the esophagus, small and large bowel (Ekci et al., 2010; Turan et al.,

This condition is commonly seen in elder males (Schmulewitz & Baillie, 2001; Stark et al, 1992). Large majority of patients having Dieulafoy's lesion might present with comorbidity

(Erickson & Glick, 1986; Rivkin & Lyakhovetskiy, 2005; Pfau et al., 2004)

**1. Introduction** 

2008).
