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Ischemic Gastropathy Treated with Celiac Artery Revascularization
Jeff Anucha1, Jonathan Pinto2, Joan Culpepper-Morgan2
1Internal Medicine, Columbia University School of Physicians and Surgeons at Harlem Hospital Center, New York, USA.
Cureus
|December 5, 2019
Summary
Ischemic gastropathy, a rare cause of upper gastrointestinal bleeding, occurs when stomach blood supply is compromised. This case highlights its diagnosis in a septic, hypotensive patient.
Area of Science:
- Gastroenterology
- Vascular Medicine
- Critical Care Medicine
Background:
- Ischemic gastropathy is infrequently diagnosed due to the stomach's extensive arterial collateral network.
- Gastric mucosal integrity relies on this redundant circulation, making diagnosis challenging.
- Upper gastrointestinal (GI) bleeding is a common presentation for various GI conditions.
Observation:
- A 76-year-old woman with hypertension, hyperlipidemia, and chronic kidney disease on dialysis presented with an upper GI bleed.
- The patient experienced sepsis and hypotension preceding the GI bleed.
- The clinical presentation suggested a potential diagnosis of ischemic gastropathy.
Findings:
- The patient's septic shock and hypotension led to reduced gastric perfusion.
- This compromised blood flow likely resulted in ischemic injury to the gastric mucosa.
- The upper GI bleed was attributed to the ischemic gastropathy.
Implications:
- This case underscores the importance of considering ischemic gastropathy in patients with upper GI bleeds, especially those with risk factors and hemodynamic instability.
- Early recognition and management of ischemic gastropathy are crucial for improving patient outcomes.
- Further research into the diagnostic and therapeutic strategies for ischemic gastropathy is warranted.
