Gastric emphysema secondary to severe vomiting: a comparative review of 14 cases

Inayat, Faisal; Zafar, Fahad; Zaman, Maseeh uz; Hussain, Qulsoom

doi:10.1136/bcr-2018-226594

Cited by 14 publications

(25 citation statements)

References 14 publications

(12 reference statements)

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“…The radiologic finding of air within the gastric wall is seen in serious conditions such as emphysematous gastritis and gastric emphysema or gastric pneumatosis, where the latter has a more benign clinical course. There are no standardized treatments or guidelines for the management of gastric emphysema, given that the current evidence is limited to a few case reports and case series [2,3]. There are several prevailing theories as to how the air disrupts the integrity of the gastric wall.…”

Section: Discussionmentioning

confidence: 99%

“…Gastric emphysema (GE) or gastric pneumatosis, defined as air within the gastric wall, is a very rare entity [ 1 , 2 ]. This happens when gastric wall integrity is disrupted, leading to air passage into the gastric wall.…”

Section: Introductionmentioning

confidence: 99%

“…This happens when gastric wall integrity is disrupted, leading to air passage into the gastric wall. Many etiologies lead to GE, such as pneumothorax, instrumentation, infection, gastric wall ischemia, and mechanical injury from excessive retching/vomiting [ 2 ]. It is important to clinically distinguish between gastric emphysema and emphysematous gastritis, given the high mortality associated with the latter.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Gastric Emphysema: Incidental Findings or Serious Illness

Reyes

Alluri

Al-Khazraji

et al. 2020

Cureus

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Gastric emphysema (GE) or gastric pneumatosis is a rare entity defined as air within the gastric wall. Etiologies include pneumothorax, instrumentation, infection, gastric wall ischemia, and mechanical injury. Several theories exist as to how the air disrupts the integrity of the gastric wall. These include a bacterial infection with Clostridium species and other gas-forming aerobic colonic bacilli, instrumentation with direct submucosal gastric wall injury, mechanical injury following increased intra-abdominal pressure, penetrating air through the mediastinum from increased intrapulmonary pressure or, gastric wall ischemia, which may be secondary to an underlying process. The diagnostic test of choice is CT of the abdomen. A hypodense linear fringe on the gastric wall is seen in GE, associated with gastric distention without thickening. In emphysematous gastritis, there is gastric wall thickening. There are no standardized guidelines for GE, but most cases have a good prognosis with a spontaneous resolution with conservation treatment. However, emphysematous gastritis management requires aggressive treatment due to the mortality rate of emphysematous gastritis approaching 60%. Patients are often considered for surgical intervention with total gastrectomy, given that active infection could delay or prevent healing. It is imperative to differentiate GE and emphysematous gastritis and understand the underlying pathogenesis as clinical outcomes are vastly different.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Case of Gastric Emphysema: Incidental Findings or Serious Illness

Reyes

Alluri

Al-Khazraji

et al. 2020

Cureus

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“…The increased intragastric pressure from excess positive airway pressure along with severe constipation could potentially cause mucosal injury and allowed air into the muscular layers of the stomach [2][3][4]. Portohepatic gas can be present in both conditions and does not necessarily require surgery [5]. GE in the setting of gastric obstruction or duodenal stenosis has been described in the past but none due to solitary constipation [3,4].…”

Section: Discussionmentioning

confidence: 99%

A case report of gastric emphysema induced by noninvasive positive airway pressure

Malik

Lattanzio

Veloso

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Gastric emphysema is a rare medical condition in which air penetrates any layer of the gastric wall (mucosa, submucosa, muscle layer, or serosa) due to a noninfectious source. It is essential to differentiate this from a life-threatening condition known as emphysematous gastritis. These two conditions have a similar presentation, and therefore, it is difficult to differentiate the two on imaging. Bi-level positive airway pressure (BiPAP) is a noninvasive intervention for selected patients in respiratory distress. This intervention uses positive airway pressure to prevent endotracheal intubation. The commonly noted side effects of positive airway pressure are dry mouth and oral irritation. This is the first case, to our knowledge, of gastric emphysema directly originating from BiPAP administration. It was diagnosed on imaging as pneumatosis intestinalis and emphysematous gastritis but clinical presentation was benign. The condition resolved immediately after discontinuation of BiPAP.

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“…Hong Kong Med J 2021;27:373.e1-2 https://doi.org/10.12809/hkmj208885 Surgical intervention is more commonly indicated for EG and is directed at removal of the septic organ, whereas the primary indication for surgical intervention in GE is uncertainty of diagnosis. 3,4 In summary, despite similar radiographic findings, GE is typically secondary to mechanical injury of the stomach mucosa, whereas EG is an acute infection of the stomach wall. The differentiation of these two entities depends on the patient's clinical presentation, assessment of predisposing factors, and CT findings.…”

Section: G Liang Lc Zeng Mg Xie * MX Zhang Zh Houmentioning

confidence: 97%