Although laparoscopic pancreatic resection of selected patients is a feasible and safe procedure in the hands of experienced laparoscopic surgeons, patients must be carefully observed after surgery to avoid serious conditions by pancreatic fistula.

GI bleeding. Although first reported by Gallard in 1896, the lesion was more accurately described by Dieulafoy in 1897. The histopathological finding is characteristic; an enlarged and torturous artery lies in close proximity to the mucosal surface, likely as a congenital anomaly. The most frequent bleeding point is the gastric fundus or body. Hemorrhage is often massive and may be life-threatening [1]. Dieulafoy's disease coexisting with gastric cancer is very rare, with 17 cases having been reported up to now [2-5] since Sasaki first reported a case in 1982. We report the successful treatment of a patient with an early gastric cancer located just above a Dieulafoy's ulcer. Case report A 69-old-man visited the emergency department of Horie General Hospital, Japan, with complaints of epigastric discomfort, repeated hematemesis, and progressive anemia, on October 30, 2003. He had a history of duodenal ulcer at the age of 25. Since 2000, he had been treated with a calcium antagonist for hypertension and with sulfonyl urea for diabetes mellitus. Emergency gastroscopy revealed massive coagula and spurting bleeding from the posterior wall of the upper third of the stomach. The bleeding was successfully stopped with an endoscopic hemoclip, using a clear attachment. Blood transfusion and a proton-pump inhibitor were administered and he recovered smoothly. He was discharged 20 days after the treatment. Followup gastroscopy was performed 2 weeks and 6 weeks after the treatment. Two weeks after the treatment, we found a slightly elevated mucosal cancer, type IIa [6], at the previous bleeding point (Fig. 1). Well-differentiated adenocarcinoma was also confirmed by endoscopic biopsy. Double-contrast radiography showed irregular mucosal convergence at the site.

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