Abstract
INTRODUCTION: Gastric ischemia is a rare condition associated with poor prognosis typically presenting with abdominal pain, GI bleed and altered mentation and may be caused due to states of shock. We present a rare case of gastric ischemia due to urosepsis. CASE DESCRIPTION/METHODS: A 70 year-old male with past medical history of peripheral vascular disease, chronic Foley catheter and dementia presented with altered mentation, hypotension, tachycardia and decreased urine output. The Foley catheter was replaced revealing purulent urine. Initial labs revealed acute kidney injury, lactic acidosis, and leukocytosis. CT abdomen pelvis without contrast revealed gastric pneumatosis with adjacent left upper quadrant portal venous gas and branching portal venous gas throughout the liver. Esophagogastroduodenoscopy was performed which showed proximal gastric ischemia and necrosis from the midbody to the fundus; biopsies revealed acute hemorrhagic gastritis, and gastroenterology recommended resection. General surgery was consulted who recommended conservative management. Patient improved clinically while receiving antibiotic therapy, intermittent nasogastric tube suction, intravenous proton pump inhibitor therapy and parenteral nutrition. Repeat imaging showed resolution of portal gas and gastric pneumatosis and repeat EGD showed resolution of gastric ischemia. DISCUSSION: Gastric ischemia is a serious condition which is under-recognized clinically. Etiologies include systemic hypotension, vasculitis or disseminated thromboembolism. Gastric pneumatosis or portal venous gas on imaging suggest ischemia; EGD with biopsy is the diagnostic gold standard. Gastric ischemia is either managed surgically or medically with fluid resuscitation, nasogastric tube placement to prevent gastric distension and acid reduction along with antibiotics for patients with gastric pneumatosis.
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