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

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.