Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202300021
Jornal Vascular Brasileiro
Case Report

Gastrite isquêmica grave por isquemia mesentérica crônica

Severe ischemic gastritis caused by chronic mesenteric ischemia

Bruno Moraes Ribas; Eduardo Camargo Rebolho; Guilherme Figueiró Ferronatto; Pedro Henrique Bragato; Hugo Genki Kagawa Akahane; Eduardo José Brommelstroet Ramos; Thienis Maria da Costa Lima; Barbara D’agnoluzzo Moreira

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Resumo

A gastrite isquêmica é uma doença rara, podendo ocorrer por insuficiência vascular focal ou sistêmica. Essa condição é raramente vista na prática médica devido à vasta rede colateral arterial do estômago pelo tronco celíaco e mesentérica superior. A apresentação clássica da isquemia crônica é formada pela tríade de dor pós-prandial, perda de peso e sopro abdominal. A intervenção está indicada naqueles pacientes sintomáticos, sendo o tratamento endovascular uma alternativa à cirurgia em pacientes com alta comorbidade, tendo bons resultados. Reportamos um caso de gastrite isquêmica grave com úlceras e sangramento que foi causado por isquemia mesentérica crônica, em uma paciente de 71 anos, com oclusão do tronco celíaco e mesentérica inferior, além de estenose crítica da superior. O diagnóstico foi confirmado por exame de imagem, e a paciente foi submetida a tratamento endovascular. Trata-se de uma condição rara de diagnóstico e tratamento desafiadores, a qual requer uma equipe multidisciplinar para o manejo adequado.

 

Palavras-chave

isquemia mesentérica, oclusão vascular mesentérica, aterosclerose, procedimentos endovasculares, gastrite

Abstract

Ischemic gastritis is a rare illness caused by localized or systemic vascular insufficiency. This condition is rarely seen in medical practice due to the vast arterial collateral blood supply to the stomach through the celiac trunk and superior mesenteric artery and also because other etiologies are much more frequent. The classic presentation of chronic ischemia is comprises the triad of postprandial pain, weight loss, and abdominal bruit. Intervention is indicated in symptomatic patients and endovascular treatment is an alternative to surgery in patients with high comorbidity that offers good results. We report a case of a 71-year-old female patient with severe ischemic gastritis with ulcers and bleeding caused by chronic mesenteric ischemia with occlusion of the celiac trunk and inferior mesenteric artery and critical stenosis of the superior mesenteric artery. The diagnosis was confirmed by imaging, and the patient underwent endovascular treatment. This is a rare condition that is difficult to diagnose and treat and a multidisciplinary team is needed for proper management.

Keywords

mesenteric ischemia; mesenteric vascular occlusion; atherosclerosis; endovascular procedures; gastritis

References

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Submitted date:
01/17/2023

Accepted date:
05/11/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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