Dieulafoy's ulcer associated with the tortuous caliber persistent arteries: report of three cases

Many papers have reported that Dieulafoy's ulcer is one of the notorious causes of gastric hemorrhage. Three cases of shallow subfundic ulcers with massive bleeding are reported. The resected specimens have demonstrated that elevated caliber-persistent artery (CPA), a branch of the left gastric artery with few anastomoses, in the base of the ulcer has tortuous penetration from the serosa to submucosa, showing patchy, eccentric intimal fibroelastosis. These findings of CPA are almost the same in both anterior and posterior walls, namely both the ruptured and contralateral sides. Thus, morphogenesis of the ulcer may have originated from anatomical deviation, which is related to regional hypertension aggravated by longterm peristalsis, as well as aging.