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\begin{document}

\title{Gastric ischemia and pulmonary embolism in a patient with acute leukemia}



\author[1]{Sondes Bizid}%
\author[1]{Fatma Ben Farhat}%
\author[1]{Younes Arous}%
\author[1]{Sonia Bennaser}%
\affil[1]{Military Hospital of Instruction of Tunis}%


\vspace{-1em}



  
  \date{May 30, 2024}


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\selectlanguage{english}
\begin{abstract}
A Tunisian male diagnosed with an acute lymphoblastic leukemia was
admitted to our hospital for a chemotherapy cure . During the
hospitalization, he presented an acute epigastric pain with fever.
Abdominal CT scan showed circumferential gastric thickening with an
enhancement defect suggestive of gastric ischemia associated with
segmental pulmonary embolism.%
\end{abstract}%



\sloppy


\textbf{Gastric ischemia and pulmonary embolism in a patient with acute
leukemia}

\textbf{Author list:}

Sondes BIZID \textsuperscript{1,4}, Fatma BEN
FARHAT\textsuperscript{1,4}, Younes AROUS\textsuperscript{2,4}, Sonia
BENNASER\textsuperscript{3,4}

1.Gastro-enterology Department , Military hospital of Tunis, Tunis,
Tunisia

2.Radiology Department, Military hospital of Tunis, Tunis, Tunisia

3.Oncology Department, Military hospital of Tunis, Tunis, Tunisia

4.University of Tunis El Manar, Faculty of Medicine, 1007, Tunis,
Tunisia

\selectlanguage{greek}\textsuperscript{\textbf{µ}}\selectlanguage{english}\textbf{Corresponding author:}

Fatma Ben Farhat,

University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunis,
Tunisia

The military hospital of Tunis, Department of Gatroenterology,
Montfleury 1008, Tunisia

\textbf{Email:\emph{Fatmabf8@gmail.com}}

\textbf{Consent:}

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

\textbf{Competing interests}

The authors declare no competing interest.

\textbf{Case}

A 41-year-old Tunisian male diagnosed with an acute lymphoblastic
leukemia was admitted to our hospital for a chemotherapy cure
(Hyper-CVAD: Cyclophosphamide, Vincristine Sulfate, Doxorubicin
Hydrochloride and Dexamethasone). During the hospitalization, he
presented an acute epigastric pain with hemodynamic instablility and
fever. Physical examination revealed abdominal tenderness. The
thoroco-abdominal CT scan showed circumferential gastric thickening with
an enhancement defect suggestive of gastric ischemia associated with
segmental pulmonary embolism (Figure 1). He was treated with
noradrenaline, intravenous fluids, intravenous proton pump inhibitors,
broad-spectrum antibiotics and anticoagulants with favorable clinical
outcome. At day 7, he underwent an upper endoscopy. It revealed
hypertophic, ulcerated fundic folds covered with false membranes with
necrotic foci, extending from the proximal body to the proximal antrum
(Figure 2). Histology was compatible to the endoscopic suspicion of
gastric ischemia. The patient was discharged after 2 weeks of medical
treatment and was reevaluated at 1 month, remaining asymptomatic.\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/image4/image4}

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\textbf{Figure 1:} CT scan findings: a- segmental pulmonary embolism

b,c,d- circumferential gastric thickening with an enhancement defect\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/image5/image5}

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\includegraphics[width=0.70\columnwidth]{figures/image8/image8}

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\textbf{Figure 2} : endoscopy findings a and b-necrosis foci

c- ulcerated fundic folds

d- antral mucosa

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