Ischaemic gastritis and perforation.

Area of Science:

• General Surgery
• Gastroenterology
• Vascular Surgery

Background:

• Gastric perforation is a frequent surgical emergency.
• Ischaemic gastritis is an uncommon etiology due to the stomach's rich vascular supply.
• Existing literature on ischaemic gastritis is limited, often associating it with gastric dilation.

Observation:

• A 52-year-old female presented with syncope, nausea, vomiting, and abdominal pain.
• Radiographic evidence of free subdiaphragmatic gas and peritonitis indicated an urgent surgical case.
• Intraoperatively, ischaemic gastritis with multiple perforations along the greater curvature was identified, leading to a sleeve gastrectomy.

Findings:

• The patient experienced a complicated post-operative course with multi-organ dysfunction and extensive bowel ischaemia.
• Despite intensive care, the patient's condition deteriorated, resulting in mortality 13 days post-operatively.
• Ischaemic gastritis, though rare, can result from proximal insults, global ischaemia, or coagulopathy and may present with bleeding or perforation.

Implications:

• Ischaemic gastritis is likely underdiagnosed, necessitating timely recognition and appropriate management based on aetiology.
• Prompt diagnosis and tailored treatment strategies are essential for improving patient outcomes in cases of ischaemic gastritis.
• Understanding the diverse aetiologies of ischaemic gastritis is key to effective clinical management and surgical intervention.