Louisiana State University Health Sciences Center Shreveport, LA, United States
Nazar Hafiz, MD1, Aditya Vyas, MD1, Kabir Husain, DO2, Kenneth Manas, MD3, James Morris, MD1 1Louisiana State University Health Sciences Center, Shreveport, LA; 2LSU Health Shreveport, Shreveport, LA; 3Ochsner Medical Center, Shreveport, LA
Introduction: Diffuse ischemia of gastric mucosa is a rare phenomenon owing to the extensive vascular supply of the stomach. Here we present a rare case of diffuse ischemia of gastric mucosa in a pt with remote history of gastric bypass surgery.
Case Description/Methods: A 67 y. o. Female with PMH of CHF, CAD s/p CABG, A. Fib on Eliquis, Gastric Bypass in 1980s with revision surgery done in 1990s, presented via EMS to the ER with a history of traumatic head injury after fall. On initial evaluation she was found to have left sided weakness and CT head revealed a right sided subdural hematoma. She underwent a right craniotomy for SDH evacuation with a replacement bone flap. Post-operative period was complicated by multiple episodes of hematemesis and decline in hemoglobin and cardio-respiratory status. GI was consulted and an EGD was performed. Esophageal mucosa was unremarkable with brownish red liquid found in distal esophagus. On entering the stomach, brownish red liquid was suctioned out to reveal diffuse necrotic, black gastric mucosa with friable tissue. Scope was withdrawn as the risk of perforation was high. Family decided to transfer the care to hospice due to poor prognosis.
Discussion: Gastric ischemia can be caused by diffuse or localized vascular insufficiency including hypotension, vasculitis and thromboembolism. We suspect gastric bypass surgery as a risk factor in this patient associated with possible hypotension causing the ischemia. Early histological changes include mucosal edema with congestion. Ongoing ischemia results in involvement of hemorrhagic necrosis along deep ulceration of the gastric wall. As clinicians we should be aware of the risk factors causing gastric ischemia as this may result in prompt identification, management and better prognosis.
Figure: Endoscopic images showing diffuse necrosis of stomach
Nazar Hafiz indicated no relevant financial relationships.
Aditya Vyas indicated no relevant financial relationships.
Kabir Husain indicated no relevant financial relationships.
Kenneth Manas indicated no relevant financial relationships.
James Morris indicated no relevant financial relationships.
Nazar Hafiz, MD1, Aditya Vyas, MD1, Kabir Husain, DO2, Kenneth Manas, MD3, James Morris, MD1. P1010 - Diffuse Necrosis of Stomach in a Patient With Remote History of Gastric Bypass Surgery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.