A case of splenic artery aplasia accompanying Dieulafoy's ulcer

A 32-year-old man presented with hematoemesis and melena. He had suffered from hematoemesis in 1992 and 1993, but the cause remained unknown. Upper gastrointestinal endoscopy revealed bleeding in the fundus of stomach close to the posterior wall of the greater curvature, suggesting the Dieulafoy's ulcer. Local injection of ethanol and clipping achieved hematostasis. As his prior history of bleeding suggested the presence of a vascular anormaly, he underwent abdominal angiography. The angiogram revealed narrowing of the splenic artery at its origin from the celiac artery, many expanding and serpiginous branches from the left gastric artery, and an aneurysm in the fundus of the stomach. To avoid rebleeding, he underwent fundusectomy and splenectomy. In this patient, Dieulafoy's ulcer was probably caused by collateral vessels that developed due to splenic artery aplasia. Young patients with a history of bleeding of unknown etiology must be checked for vascular anormaly.