Ischemic Gastroduodenitis: Navigating the Challenges of Enteral Nutrition Resumption

ABSTRACT Ischemic gastritis (IG) and ischemic duodenitis (ID) are rare due to the extensive anastomotic vascular supply arising from the celiac trunk. Profound splanchnic hypoperfusion is required to induce a clinically significant ischemic insult. Etiologies typically include systemic hypotension, vasculitis, or thromboembolism. Patients with IG/ID often face high morbidity and mortality given the severity of ischemia required to induce extensive mucosal damage, leaving clinicians to balance prolonged bowel rest and early enteral feeding. We present the case of an 18-year-old man with spastic quadriplegic cerebral palsy and developmental delay who developed severe IG/ID in the setting of severe hemorrhagic shock. He presented to our institution with hemodynamic instability, profound anemia, and signs of upper gastrointestinal bleeding. Endoscopic evaluation found the patient to have severe IG/ID necessitating prolonged bowel rest and total parenteral nutrition (TPN). After evidence of mucosal recovery on surveillance endoscopy, he was gradually transitioned from TPN to enteral nutrition and successfully discharged to a long-term care facility. This report describes the successful reintroduction of enteral feeding in a patient with severe IG/ID after prolonged bowel rest. The use of surveillance endoscopy to guide the gradual reintroduction of enteral feeding, alongside careful TPN weaning, allowed for the successful discharge of a patient with IG/ID, a condition associated with poor outcomes.