Ischemic gastropathy: Early diagnosis and benign evolution in an elderly woman

Abstract

The authors present the case of an 82 year-old female patient observed at the emergency department with upper gastrointestinal bleeding and abdominal pain. The patient referred diffuse abdominal cramps and episode of coffee-ground emesis in the last 3--4 h. She denied any other abdominal, respiratory or urinary symptoms and the ingestion of non-steroidal anti-inflammatory drugs or corticosteroids and recent hospitalization or surgery. The patient had a chronic history of atrial fibrillation treated with amiodarone (200 mg qd). She also took omeprazole (20 mg qd) on regular basis. She presented normal vital signs, level of consciousness and no fever. Cardio-pulmonary auscultation was normal, except for the presence of arritmic heart sounds. The abdomen was distended and tender especially at the upper quadrants with decreased bowel sounds. Rectal examination excluded melena, but the nasogastric aspiration returned a hematic gastric content. Blood tests showed leukocytosis, Hb 11.9 g/dL, and a CRP of 46 mg/L. Coagulation, platelet count, liver function tests, renal function and electrolytes were all within normal range. Plain abdominal film excluded perforation.