Emphysematous gastritis: Case report and literature review

Abstract

Emphysematous gastritis is a rare form of gastritis that results from infection of the stomach wall by gas-forming organisms. Diagnosis of this commonly fatal condition rests on radiological demonstration of gas within the stomach wall. This can be observed on plain radiographs or CT scans of the abdomen. Only by prompt diagnosis and treatment can mortality be avoided. A new case of empysematous gastritis, diagnosed on CT scan by the demonstration of both intramural and portal venous gas, is presented and the literature is reviewed.

Successful Conservative Treatment of Emphysematous Gastritis

“…The prognosis is extremely unfavorable, with a mortality rate of 55-61% (2-4). The condition is associated with the ingestion of corrosives, such as ammonia and acid, alcohol abuse, diabetes, renal failure, gastroenteritis, recent abdominal surgery, long-term steroid use, pancreatitis and nonsteroidal antiinflammatory drug use (5). In other words, it is believed that emphysematous gastritis is triggered by factors such as pharmaceuticals and ischemia that damage the gastric mucosal barrier.…”

“…CT is the most effective diagnostic imaging modality, as it can be used to identify even small areas of interstitial emphysema (3,5). Plain abdominal radiography is useful for imaging gas within the distended stomach as well as detecting interstitial emphysema.…”

“…Studies have identified gastric outlet obstruction, excessive vomiting, nasogastric tube placement, cardiopulmonary resuscitation and stomach ulcers to be causative factors in such cases (11). Characteristic CT findings of emphysematous gastritis include irregular, mottled gas in the stomach wall, while gastric emphysema is indicated by the presence of thin linear gas in the stomach wall (5).…”

Emphysematous gastritis after bone marrow transplant: Successful conservative management

“…Known associated conditions include ingestion of corrosives, alcohol abuse, renal failure, diabetes, non-steroidal anti-inflammatory drug usage, pancreatitis, gastroenteritis and recent abdominal surgery [2,3]. There have been cases of associated bacterial infection with Clostridium welchii, Escherichia coli, Streptococcus, Bacillus subtilis, proteus, Pseudomonas and Enterobacter [1,4].…”

“…Typically, gas is unusual within the stomach due to its mucosal barrier, acidity, and strong blood supply [3,4]. It can be a sign of underlying disease and is found in EG as well as gastric emphysema.…”