# Gastric ischemia as an under-reported cause of death in older people

## TL;DR

This paper presents a rare case of fatal gastric ischemia in an older person, only identified post-mortem, highlighting its under-recognition as a cause of death.

## Contribution

The paper emphasizes the importance of considering gastric ischemia as a rare but possible cause of death in older individuals.

## Key findings

- Gastric and bowel ischemia was confirmed through post-mortem examination and histological analysis.
- The ischemia was non-occlusive, likely due to systemic hypoperfusion rather than mechanical blockage.
- The case highlights the need for thorough clinical and forensic evaluation in suspected rare causes of death.

## Abstract

Acute gastric ischemia is a rare condition due to the rich vascular supply of the stomach. Here we present a case of fatal gastric ischemia associated with bowel ischemia, only diagnosed at autopsy, which was requested for the suspicion of medical liability. A complete post-mortem examination was conducted, along with a macroscopic analysis of the superior mesenteric artery and detailed histological analyses. Past clinical data was also reviewed. The macroscopic blackish discoloration of the stomach and the bowel, coupled with the presence of neutrophils in the mucosa and submucosal non-occlusive thrombi, were consistent with gastric and bowel ischemia, despite the presence of confounding putrefactive changes. The unique aspect of this case resides in the ante-mortem peculiar vascularization of the stomach, supplied by small collateral vessels. No mechanical occlusion was identified, and the cause of the ischemia was deemed as non-occlusive, likely due to systemic hypoperfusion. The analysis of clinical data and documentation of associated comorbidities are strongly recommended, especially when a rare cause of death is suspected. With the aging population, especially among women, and the prevalence of risk factors, the forensic pathologist could increasingly encounter rare cases of gastric ischemia.