噴出状出血により大量吐血をきたした胃癌の1例

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  • A CASE OF GASTRIC CANCER WITH SPURTING MASSIVE BLEEDING FROM EXPOSED VESSEL

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A 45-year-old male in shock condition due to massive hematemesis was urgently admitted to our hospital. Urgent endoscopic examination of upper GI tract demonstrated an advanced gastric cancer with massive spurting bleeding from exposed vessel in an ulcerated lesion. Endoscopic hemostasis was succesfully carried out with local injection of absolute ethanol. After further examination, scheduled radical operation (total gas-trectomy and splenectomy with lymphnode dissection) was performed. Pathological study proved the presence of a ruptured artery 850μm in diameter in the ulcerated cancerous lesion. The wall components of that artery were degenerated with ethanol injection. The incidece of gastric cancer with massive hemorrhage, which was considered to need urgent operation, was rare. However, it is very difficult to determine whether urgent operation is needed or not because of poor general condition of the patient due to malignancy. Recenly, the massive hematemesis from exposed artery in benign gastroduodenal ulcer was successfully controlled by injecting ethanol. Likewise, massive gastric bleeding from exposed vessel in cancer tissue was also thought to be controlled with this method. This method should be taken in consideration for scheduled radical operation after hemostasis. Relatively low incidence of massive bleeding from gastric cancer in comparison with gastroduodenal ulcer was due probably to rare presence of exposed large vessels in the lesions.

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