Intramural gas in stomach along with acute calculus cholecystitis: an unusual association

Abstract

Intramural gas in stomach is a rare finding, but differential diagnosis of this condition into gastric emphysema and emphysematous gastritis is clinically important because of vastly different aetiologies and prognosis. Emphysematous gastritis is caused by gas producing micro-organisms inside the stomach wall and is a potentially fatal condition, while, on the other hand, gas enters stomach wall through mucosal breach in the case of gastric emphysema and prognosis is usually good with complete resolution. To date, no case has been reported in the literature showing gas in the stomach wall in a patient with acute calculus cholecystitis. We present a case of a young man with upper abdominal pain, and who, upon diagnostic work up was diagnosed with acute calculus cholecystitis with associated intramural gas in the stomach with no known aetiological factors to be positive. Conservative management with close observation resulted in complete symptomatic resolution.

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

“…Air in the stomach wall is a rare finding. Two conditions are included in the differential diagnosis of intramural gas in stomach: emphysematous gastritis and gastric emphysema ( 1 ).…”

“…Gastric emphysema is a more benign condition in which air usually reaches within the wall from outside ( 1 ). The predisposing factors for gastric emphysema are mucosal disruption due to procedures like endoscopy ( 10 ) or nasogastric tube placement ( 11 ), increased intraluminal pressure secondary to pyloric or enteral stenosis ( 12 , 13 ), gastric paresis and forceful vomiting, and chest wall injuries.…”

“…It is important to differentiate emphysematous gastritis from gastric emphysema mostly because of the difference in management and prognosis. Emphysematous gastritis usually presents in a sick, hemodynamically unstable patient and has increased mortality ( 1 – 5 ). It might also have an increased association of radiological finding of gas in the portal venous system in addition to the intramural stomach gas ( 5 ).…”

“…It is an acute life-threatening condition resulting from gas-producing microorganism 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 ( 1 – 3 ). Surgical intervention is reserved for perforations, peritonitis, strictures, and uncontrolled disseminated sepsis ( 2 , 3 ).…”

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“…[4][5][6] With the mucoadhesive system there has also been reports of pain, due to removal of mucus by the sticky starch. There by resulting in weak defensive action against acid-pepsin, and further leading to ulcer.…”