A combination of intramural stomach and portal venous air: conservative treatment

Abstract

Emphysematous gastritis is a severe and rare form of gastritis with characteristic findings of intramural gas in the stomach. It is an acute life-threatening condition resulting from gas-producing microorganisms invading the stomach wall. Early diagnosis and initiation of treatment with bowel rest, hydration, and intravenous broad-spectrum antibiotics is imperative for an effective outcome. Surgical intervention is reserved for perforations, peritonitis, strictures, and uncontrolled disseminated sepsis. We present a case of an 82-year-old female with prior history of colon and uterine cancer on remission treated with surgeries who presented with bilious vomiting, abdominal discomfort, and nausea. She was tachycardic and had a diffusely tender abdomen with rebound on examination. Her laboratory results including blood count, serum chemistry, and coagulation studies were normal. She was diagnosed with emphysematous gastritis based on the characteristic radiographic findings of intramural stomach gas and also the presence of gas in the portal venous system. It is important to differentiate emphysematous gastritis from gastric emphysema because of the difference in management and prognosis, as emphysematous gastritis has a worse outcome and requires aggressive management. Despite an anticipated poor prognosis due to the known grave outcomes of emphysematous gastritis, our patient was successfully managed with conservative treatment. We concluded that she developed emphysematous gastritis probably secondary to immunosuppression and possible mucosal tears from multiple bouts of vomiting. She had a stable hospital course and resolution with medical management most likely due to early diagnosis and initiation of appropriate treatment.

Emphysematous gastritis: A case series of three patients managed conservatively

“…The diagnosis of EG is most commonly and best established on CT scan of the abdomen, although abdominal roentgenogram may be sufficient to make the diagnosis [3,7]. The extent of gastric emphysema as well as presence of portal venous gas and pneumoperitoneum in this setting do not correlate with the severity of disease or need for operative management [4,10,11]. Two of our reported cases had portal venous gas or pneumoperitoneum but did not require exploration given their relative stability, absence of peritoneal signs, and response to conservative management.…”

Air in the gastric wall of a patient with AIDS

“…Emphysematous gastritis is a rare infection of the gastric wall with 55%-60% mortality [5] . Gas-forming organisms such as Clostridium perfringens , Pseudomonas aeruginosa , Staphylococcus aureus , Escherichia coli , and Enterobacter species are the most common culprits [6] , and it is also potentially associated with the rarer bacterium Sarcina ventriculi [7] .…”

“…This gas arises from barotraumas such as in gastric outlet obstruction, mucosal tears, gastric ulcers, nasogastric tube placement, endoscopy, and cardiopulmonary resuscitation [3] , [4] . Often, gastric emphysema is associated with mild to no symptoms and gastric linear lucencies on imaging, resolving spontaneously in most cases [5] .…”

Axillary manifestations of dermatologic diseases: a focused review

“…FFD presents as flesh-colored to reddish-brown pruritic domeshaped papules in apocrine gland-bearing regions such as the axillae, groin, areolae, and inframammary folds ( Fig. 6) (21,(23)(24)(25). FFD affects women predominantly of child-bearing age and tends to resolve after menopause (24,26).…”