Clinical features and progress of ischemic gastritis with high fatalities: Seven case reports

Table 1 Demographic and clinical data of seven patients

April 2016 to September 2021: n = 7 patients
Characteristics
Age	Mean age of 75 yr (range 53-90 yr)
Sex	Five men, two women
Chief complaint	Hematemesis: 7/7 (100%)
Shock at presentation	6/7 (86%)
Past medical history
Diabetes	2/7 (28%)
Dyslipidemia	2/7 (28%)
Hypertension	3/7 (43%)
Chronic kidney disease	3/7 (43%)
Hyperuricemia	1/7 (14%)
Heart failure	2/7 (28%)
Any vascular diseases	3/7 (43%)
Smoking	History of smoking: 2/7 (28%); never smoking: 4/7 (57%)
Medicine
Anticoagulants (warfarin)	1/7 (14%)
Antiplatelet (aspirin)	1/7 (14%)
Endoscopic findings
Distribution	Stomach: 3/7 (43%); esophagus to duodenum: 4/7 (57%)
Second endoscopy	1/7 (14%)
Patients undergoing CT scan before endoscopy	7/7 (100%) On the day: 3; 2 d before: 1; 3 d before: 1; 9 d before: 1; 14 d before: 1
CT findings	Wall thickening in the stomach: 4/7 (57%); mural emphysema in the stomach: 3/7 (43%)
	Calcification at the origin of the celiac artery: 2/7 (43%); compression of the celiac artery by the median arcuate ligament: 1/7 (14%)
Operation before illness onset	4/7 (57%) Splenectomy: 1; Aortic valve replacement: 1; Ascending aorta replacement: 1; Lung cancer operation and superior vena cava repair: 1
Treatment	Conservative treatment: 7/7 (100%)
Mechanical assistance	CHDF: 3/7 (43%)
Outcome	Death: 7/7 (100%)
Time from onset to death
1-14 d	5/7 (71%)
15-28 d	1/7 (14%)
-29 d	1/7 (14%)

CT: Computed tomography; CHDF: Continuous hemodiafiltration.

Table 2 Clinical characteristics of each ischemic gastritis patient

Case	Age	Sex	Symptoms	Shock at presentation	Underlying disease	Operation before onset	Anticoagulants	Antiplatelet	Treatment	Mechanical assistance	Surgery contraindications	Outcome	Time from onset to death (d)	Cause of death
1	90	F	Hematemesis	Yes	CHF, CKD, OCI, diabetes	None	Warfarin	No	Conservative	No	Poor general condition	Death	28	CHF
2	72	M	Hematemesis	Yes	AAA, OMI	Splenectomy	No	No	Conservative	No	Poor general condition	Death	2	Splenic hemorrhage
3	53	F	Hematemesis	No	Depression	None	No	No	Conservative	No	Poor general condition	Death	14	Hypoxic encephalopathy
4	84	M	Hematemesis	Yes	AVS, CKD, CHF, thoracic aneurysm, hypertension	AVR	No	Aspirin	Conservative	CHDF	Poor general condition	Death	12	Multi organ failure
5	79	M	Hematemesis	Yes	AAA, hypertension	AAR	No	No	Conservative	CHDF	Poor general condition	Death	2	Aspiration pneumoniae
6	71	M	Hematemesis	Yes	IVF, CKD, hypertension, dyslipidemia, diabetes	None	No	No	Conservative	No	Poor general condition	Death	2	Myocardiac infarction
7	77	M	Hematemesis	Yes	OMI, dyslipidemia, lung cancer	Lung cancer operation (superior vena cava repair)	No	No	Conservative	CHDF	Poor general condition	Death	298	Septic shock

CHF: Chronic heart failure; CKD: Chronic kidney disease; OCI: Old cerebral infarction; AAA: Abdominal aortic aneurysm; OMI: Old myocardiac infarction; AVS: Aortic valve stenosis; IVF: Idiopathic ventricular fibrillation; AVR: Aortic valve replacement; AAR: Ascending aorta replacement.

Table 3 Endoscopic/computed tomography findings and treatment in each ischemic gastritis patient

Case	Endoscopic findings				Endoscopic distribution	Date of CT scan from endoscopy	CT findings
	Longitudinal ulcers	Irregular multiple ulcers	Mucosal edema with redness and erosion	Hemorrhage
1	Yes	Yes	Yes	No	Esophagus to duodenum	On the day	Dilatation and edematous thickening of the wall of duodenum and ileum. Calcification at the origin of the celiac artery
2	Yes	Yes	Yes	Yes	Stomach	On the day	Hematoma around the spleen
3	Yes	Yes	Yes	Yes	Stomach	On the day	Fluid accumulation from the stomach to the large intestine. Compression of the celiac artery by the median arcuate ligament
4	Yes	Yes	Yes	Yes	Esophagus to duodenum	3 d	Wall thickening and mural emphysema and fluid retention in the stomach
5	Yes	Yes	Yes	Yes	Esophagus to duodenum	9 d	Wall thickening in the stomach
6	Yes	Yes	Yes	Yes	Esophagus to duodenum	2 d	Wall thickening and mural emphysema and fluid retention in the stomach. Calcification at the origin of the celiac artery
7	Yes	Yes	Yes	No	Stomach	14 d	Wall thickening and mural emphysema and fluid retention in the stomach

CT: Computed tomography.