title: Lethal nature of ischemic gastropathy: a case report of celiomesenteric vascular insufficiency.
abstract: Celiomesenteric ischemia has an insidious onset and the non-specific symptoms are often misdiagnosed as cholecystitis or peptic ulcer disease with a consequential delay between the onset of symptoms and radiological evidence of vascular occlusive disease. A elderly man was hospitalized after a 2-3 week history of acute abdominal pain, frequent vomiting, and chronic diarrhea associated with bloody stools. Upper gastrointestinal endoscopy showed a cobblestone gastric pattern with multiple ulcerated areas and the specimens indicated focal full thickness coagulative necrosis of the mucosa. A magnetic resonance angiography (MRA) revealed a widespread and severe atheromatous disease characterized by a hemodynamically significant stenosis of the celiac tripod, pre-occlusive stenosis of the superior mesenteric artery and complete occlusion of the inferior mesenteric artery. MRA is now the best and most accessible noninvasive examination to help establish a diagnosis, providing high-quality three-dimensional images of the celiac axis and mesenteric arteries. However, the various features observed in this case such as the clinical history, the presence of a cobblestone pattern with multiple ulcerated areas in the stomach, the coagulative-type necrosis and ischemic atrophy of the adjacent mucosa were considered diagnostic of gastric ischemia.
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, San Salvatore Hospital, Piazzale Cinelli, 1, 61100, Pesaro, Italy. ldeluca@interfree.it.
authors.forename: Luca
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Department of Clinical Medicine, University of Bologna, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ricciardiello
authors.affiliation: Department of Cardiovascular Surgery, Catholic University of Campobasso, Campobasso, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Modugno
authors.affiliation: Department of Cardiovascular Surgery, Catholic University of Campobasso, Campobasso, Italy.
authors.forename: Carlo Maria
authors.initials: CM
authors.lastname: De Filippo
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, San Salvatore Hospital, Piazzale Cinelli, 1, 61100, Pesaro, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Baroncini
keywords: Celiomesenteric stenosis; Coagulative necrosis; Gastric ischemia