S6455 Gastric Ischemia

Introduction: Gastric ischemia is uncommon due to the vast vascular supply of the stomach. Risk factors for gastric ischemia include atherosclerosis, vasculitis, gastric volvulus, DIC, shock, and post-surgical complication. This case aims to increase the index of suspicion for gastric ischemia, which has an overall poor prognosis. Case Description/Methods: A 73-year-old man with a history of hypertension and diabetes presented with severe abdominal pain and emesis for 1 day. He had an episode of bright red blood per rectum at the outside hospital. He was hypotensive and hypothermic with a white blood cells 21.1, hemoglobin 11.2, and lactic acid 20. He was intubated due to declining GCS. He required initiation of 2 pressors and broad-spectrum antibiotics. Initial nasogastric tube output was notably dark, and he was started on intravenous pantoprazole twice daily as well. Computed tomography angiography abdomen was concerning for active hemorrhage in his stomach. Emergent esophagogastroduodenoscopy (EGD) showed a subjectively ischemic greater curvature of the stomach with congested, hemorrhagic, pale, and friable mucosa. Surgical intervention was deferred given patient was an overall poor surgical candidate. Discussion: Endoscopic findings that are suggestive of gastric ischemia vary based on etiology and whether it’s acute or chronic. Findings may include pale mucosa, congested mucosa, hemorrhagic mucosa, ulcerations, or necrosis. In a case series of 15 patients, the most common location was the greater curvature of the stomach. Management of gastric ischemia involves nasogastric tube decompression (ischemia can be exacerbated by gastric distension), initiation of a proton pump inhibitor, and interventional radiology or surgery consultation depending on the etiology. Unfortunately, the prognosis of gastric ischemia remains poor despite these measures.