Ischemic Gastritis: A Rare Case of Acute and Chronic Etiology · Ischemic Gastritis: A Rare Case of...
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Designed by Michelle Brozowski David M. Chaletsky, MD, Seth J. Richter, MD, David M. Jones, MD Albany Medical College; Division of Gastroenterology, Department of Pathology, Albany, New York Ischemic Gastritis: A Rare Case of Acute and Chronic Etiology * Ischemic gastritis can be secondary to both acute and chronic injury. * Certain circumstances are amenable to a non-surgical con- servative treatment approach. Conclusion: Background: * The abundant vascular supply of oxygenated blood to the stomach via major arteries and smaller collateral vessels provides resistance to mucosal ischemia. * However, changes can occur in the acute vaso- occlusive setting after a major operative procedure, or with chronic mesenteric insufficiency. * Gastric ischemia can be quite severe and, in the presence of necrosis, causes significant morbidity. * A common diagnostic and treatment modality is surgery. Pathology: Gastric biopsy, Hematoxylin and Eosin stain 100x: Mucosal necrosis, consistent with ischemia. Gastric biopsy, Hematoxylin and Eosin stain 40x: Superficial mucosal necrosis with lamina propria hemorrhage, consistent with ischemia. Abstract: The abundant vascular supply of oxygenated blood to the stomach via major arteries and smaller collateral vessels provides resistance to mucosal ischemia. However, changes can occur in the acute vaso-occlusive setting after a major operative procedure, or with chronic mesenteric insufficiency. We present a patient who developed diffuse gastric ischemia one day after coronary bypass surgery during a one month hospitalization for a global ischemic event. A 67 year-old female developed bright red blood output from her oral-gastric tube one day after coronary bypass surgery using a saphenous vein graft. Her bowel movements were loose and without hematochezia. She had no prior history of GI bleeding. She was initially hospitalized one month prior to the surgery for non-ST elevation myocardial infarction and cardiogenic shock with assoc- iated elevation of liver transaminases and acute renal failure. She was treated with aspirin, prophylactic esomeprazole, and vaso- pressors during her hospital course. She had a history of atherosclerotic disease and smoked tobacco regularly. She was intubated and sedated, with mean arterial blood pressure 81 mmHg and central venous pressure 9 cmH O. Examination demonstrated hypo-active bowel sounds and a soft abdomen. Hemoglobin was 10.6 g/dL, pH 7.46, lactic acid 1.8 mmol/L, and stool was hemoccult negative. EGD revealed severe ulceration and friability throughout the entire gastric mucosa, with a normal esophagus and duodenum. Gastric biopsies demonstrated diffuse mucosal necrosis with pre- servation of only 1/3 of the mucosa, consistent with ischemia. Colonoscopy was normal. Conservative medical management was provided with an intravenous proton pump inhibitor and TPN. Five days later, she was extubated and began a liquid diet without complication. She was discharged from the hospital one week later. Mesenteric ischemia of the small and large bowel are more commonly investigated than the stomach. Gastric ischemia can be quite severe and, in the presence of necrosis, causes significant morbidity. A common diagnostic and treatment modality is surgery. Prior reports demonstrate either an acute or chronic etiology. We present a rare patient with ischemic gastritis and mucosal necrosis secondary to both acute and chronic injury, successfully treated with medical therapy. We conclude that certain circumstances are amenable to a conservative treatment approach. 2 Gastric Fundus: Ischemic gastritis Gastric Body: Ischemic gastritis Endoscopy:
Transcript of Ischemic Gastritis: A Rare Case of Acute and Chronic Etiology · Ischemic Gastritis: A Rare Case of...
Designed by Michelle Brozowski
David M. Chaletsky, MD, Seth J. Richter, MD, David M. Jones, MD
Albany Medical College; Division of Gastroenterology, Department of Pathology, Albany, New York
Ischemic Gastritis: A Rare Case of Acute and Chronic Etiology
* Ischemic gastritis can be secondary to both acute and chronic injury.
* Certain circumstances are amenable to a non-surgical con- servative treatment approach.
Conclusion:
Background:
* The abundant vascular supply of oxygenated blood to the stomach via major arteries and smaller collateral vessels provides resistance to mucosal ischemia.
* However, changes can occur in the acute vaso- occlusive setting after a major operative procedure, or with chronic mesenteric insufficiency.
* Gastric ischemia can be quite severe and, in the presence of necrosis, causes significant morbidity.
* A common diagnostic and treatment modality is surgery.
Pathology:
Gastric biopsy, Hematoxylin and Eosin stain 100x: Mucosal necrosis, consistent with ischemia.
Gastric biopsy, Hematoxylin and Eosin stain 40x: Superficial mucosal necrosis with lamina
propria hemorrhage, consistent with ischemia.
Abstract:The abundant vascular supply of oxygenated blood to the stomach via major arteries and smaller collateral vessels provides resistance to mucosal ischemia. However, changes can occur in the acute vaso-occlusive setting after a major operative procedure, or with chronic mesenteric insufficiency. We present a patient who developed diffuse gastric ischemia one day after coronary bypass surgery during a one month hospitalization for a global ischemic event.
A 67 year-old female developed bright red blood output from her oral-gastric tube one day after coronary bypass surgery using a saphenous vein graft. Her bowel movements were loose and without hematochezia. She had no prior history of GI bleeding. She was initially hospitalized one month prior to the surgery for non-ST elevation myocardial infarction and cardiogenic shock with assoc-iated elevation of liver transaminases and acute renal failure. She was treated with aspirin, prophylactic esomeprazole, and vaso-pressors during her hospital course. She had a history of atherosclerotic disease and smoked tobacco regularly. She was intubated and sedated, with mean arterial blood pressure 81 mmHg and central venous pressure 9 cmH O. Examination demonstrated hypo-active bowel sounds and a soft abdomen. Hemoglobin was 10.6 g/dL, pH 7.46, lactic acid 1.8 mmol/L, and stool was hemoccult negative. EGD revealed severe ulceration and friability throughout the entire gastric mucosa, with a normal esophagus and duodenum. Gastric biopsies demonstrated diffuse mucosal necrosis with pre-servation of only 1/3 of the mucosa, consistent with ischemia. Colonoscopy was normal. Conservative medical management was provided with an intravenous proton pump inhibitor and TPN. Five days later, she was extubated and began a liquid diet without complication. She was discharged from the hospital one week later.
Mesenteric ischemia of the small and large bowel are more commonly investigated than the stomach. Gastric ischemia can be quite severe and, in the presence of necrosis, causes significant morbidity. A common diagnostic and treatment modality is surgery. Prior reports demonstrate either an acute or chronic etiology. We present a rare patient with ischemic gastritis and mucosal necrosis secondary to both acute and chronic injury, successfully treated with medical therapy. We conclude that certain circumstances are amenable to a conservative treatment approach.
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Gastric Fundus: Ischemic gastritis
Gastric Body: Ischemic gastritis
Endoscopy:
