Gastric ischemia rarely occurs because of the rich vascular supply to the stomach. Reported cases of this condition have required gastric resection. A 74-year-old man who presented with upper gastrointestinal bleeding causing hypotension is described. The diagnosis was made on gastroscopy which showed diffuse mucosal necrosis of the entire stomach and proximal duodenum. An arterial occlusion was confirmed on celiomesenteric arteriography, which demonstrated complete stenosis of the celiac axis with extensive formation of collateral vessels from the superior mesenteric artery. Mucosal biopsies of the stomach were consistent with ischemic gastritis. Given the patient's comorbid illnesses and the fact that he remained well clinically, no surgical intervention was performed. Repeat gastroscopies performed one week and six weeks after the patient's initial presentation demonstrated evidence of gastric mucosal regeneration and healing. These observations suggest that, despite a high mortality and morbidity reported in the literature, necrotizing gastric ischemia can be reversible and may not always require surgical resection.

NEXT ABSTRACT >