Lethal nature of ischemic gastropathy: a case report of celiomesenteric vascular insufficiency

Abstract

Celiomesenteric ischemia has an insidious onset and the non-specific symptoms are often misdiagnosed as cholecystitis or peptic ulcer disease with a consequential delay between the onset of symptoms and radiological evidence of vascular occlusive disease. A elderly man was hospitalized after a 2-3 week history of acute abdominal pain, frequent vomiting, and chronic diarrhea associated with bloody stools. Upper gastrointestinal endoscopy showed a cobblestone gastric pattern with multiple ulcerated areas and the specimens indicated focal full thickness coagulative necrosis of the mucosa. A magnetic resonance angiography (MRA) revealed a widespread and severe atheromatous disease characterized by a hemodynamically significant stenosis of the celiac tripod, pre-occlusive stenosis of the superior mesenteric artery and complete occlusion of the inferior mesenteric artery. MRA is now the best and most accessible noninvasive examination to help establish a diagnosis, providing high-quality three-dimensional images of the celiac axis and mesenteric arteries. However, the various features observed in this case such as the clinical history, the presence of a cobblestone pattern with multiple ulcerated areas in the stomach, the coagulative-type necrosis and ischemic atrophy of the adjacent mucosa were considered diagnostic of gastric ischemia.

Cellular Stress and Molecular Responses in Bladder Ischemia

“…It is believed that aging-associated sex-independent mechanisms involving local changes in bladder arterial supply initiate molecular responses within the smooth muscle cells, epithelium, and nerve fibers and lead to overactive detrusor contractions [ 10 , 11 , 12 , 13 ]. This is consistent with reports of smooth muscle hypersensitivity and overactive contractile activity in other moderately ischemic organs, including the stomach, gut, uterus, bronchioles, urethra, and the cardiovascular system [ 14 , 15 , 16 , 17 ].…”

Ischemic Gastropathy Treated with Celiac Artery Revascularization

“…She was on diuretics, which has been reported as a possible contributing factor, as well as intermittent hemodialysis, which has been shown to cause accelerated rates of atherosclerotic plaques [7-8]. In previous case reports reviewed, the diagnosis of gastric ischemia was often delayed because of the time spent on eliminating more common conditions, whilst a lack of response to maximal antacid therapy was observed [9-11]. For the gastrointestinal endoscopist, there should be a high index of suspicion when there are gastric ulcers in patients at risk for vascular disease [12].…”