Case Report Ischemic Gastropathic Ulcer Mimics Gastric Cancer Saleh Daher, 1 Ziv Lahav, 2 Ayman Abu Rmeileh, 2 Meir Mizrahi, 3 and Tawfik Khoury 1 1 Division of Gastroenterology and Hepatology, Department of Medicine, Hebrew University-Hadassah Medical Center, P.O. Box 12000, Ein Kerem, 91120 Jerusalem, Israel 2 Department of Internal Medicine, Hebrew University-Hadassah Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel 3 Division of Gastroenterology and Hepatology, Advanced Endoscopy Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 458, Boston, MA 02215, USA Correspondence should be addressed to Tawfk Khoury; tawfkkhoury1@hotmail.com Received 21 February 2016; Revised 28 June 2016; Accepted 19 July 2016 Academic Editor: R. J. L. F. Lofeld Copyright © 2016 Saleh Daher et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gastric ulcer due to mesenteric ischemia is a rare clinical fnding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. Te diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved afer surgical revascularization of both the superior mesenteric artery and the celiac trunk. 1. Introduction Chronic mesenteric ischemia classically presents as “abdom- inal angina,” characterized by generalized postprandial ab- dominal pain lasting up to 3 hours, as well as weight loss and upper-abdominal bruit. Symptoms are not specifc and ofen mistakenly attributed to other gastrointestinal etiolo- gies, such as peptic ulcer or gallstones. Gastric ischemia is not commonly encountered because of the rich collateral blood supply to the stomach, making gastric ulceration from ischemia a rare condition [1–3]. Gastric ischemia manifested as gastric ulcer might result from localized or difuse vascular insufciency caused by etiologies such as systemic hypoten- sion, vasculitis, or localized thromboembolism. However, Helicobacter pylori (HP) infection is considered to be the major cause of peptic ulcer disease, and the use of nons- teroidal anti-infammatory drugs (NSAIDs) accounts for the majority of the remainder [4]. Herein we report a long- standing case of chronic mesenteric ischemia where an HP- negative gastric ulcer and not associated with the use of NSAIDs was detected in the initial evaluation. Te pa- tient’s complaints ultimately responded to revascularization surgery, with resolution of his non-NSAID, non-HP gastric ulcers. 2. Case Report A 46-year-old male presented with progressive, mostly post- prandial abdominal pain, and signifcant weight loss of almost 44 lb. in a six-month period. His medical history was notable for heavy smoking for the past 30 years and cholelithiasis. His medications included 40 mg esomeprazole once a day. Four months prior to presentation, he underwent an esophagogastroduodenoscopy (EGD) to evaluate similar complaints and was diagnosed with peptic ulcer disease (PUD) with positive HP. No improvement followed a course of a high dosage of esomeprazole and Helicobacter eradica- tion therapy. On admission the patient was stable, with a heart rate of 65 beats/min., blood pressure of 110/60 mmHg, and oxygen saturation of 98%. His physical examination was unremark- able except for epigastric tenderness and bilateral temporal and extremities wasting. Laboratory tests revealed normal CBC, kidney, and liver function. His C-reactive protein and erythrocyte sedimentation rate were also unremarkable. Upon admission, a review of a computed tomography (CT) scan was done in an outpatient setting and revealed fatty liver, thickened gastric wall (Figure 1), and a hypodense Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2016, Article ID 9745854, 4 pages http://dx.doi.org/10.1155/2016/9745854