MASSIVE ARTERIAL HEMORRHAGE FROM THE LOWER GASTROINTESTINAL-TRACT

We have studied the clinical, radiological and pathological features o f three patients with recurrent massive lower gastrointestinal arteria l haemorrhage, Case 1 was an example of Dieulafoy's vascular malformat ion within the proximal ascending colon in a 46-year-old woman, Cases 2 and 3 were men aged 81 and 83 years with arterial erosions contained within small mucosal diverticula in the hepatic flexure and descendin g colon, respectively, All three patients presented with recurrent acu te episodes of massive lower gastrointestinal haemorrhage. Selective m esenteric angiography was performed in cases 1 and 3 to localize the b leeding point in both patients, The features were very different to th ose of angiodysplasia, lacking the tuft of abnormal vessels and the ea rly venous filling phase commonly seen in the latter condition. The pa tients were all successfully treated by partial colectomy, The aetiolo gy of Dieulafoy's vascular malformation remains unclear, The ruptured arteries in cases 2 and 3 shared many histological features with the D ieulafoy lesion in case 1. The lesions in cases 1 and 2 were associate d with recent oral non-steroidal anti-inflammatory therapy. suggesting coincidental mucosal ulceration as a contributory factor.