Vomiting-Induced Gastric Emphysema and Hepatoportal Venous Gas: A Case Report and Review of the Literature

Abstract

Gastric pneumatosis is the presence of air within the wall of the stomach. It represents a spectrum of conditions ranging from benign disease to septic shock and death. Etiopathologically, it can be classified into emphysematous gastritis or gastric emphysema (GE). Along with hepatoportal venous gas (HPVG), it was considered as an ominous radiological sign and warranted an emergent surgical exploration; however, with widespread use of computerized tomographic (CT) scan, an increasing number of benign causes of GE and HPVG have been reported in the literature, where patients can be managed by noninvasive and conservative measures. We hereby describe a case where recurrent episodes of vomiting led to development of GE and HPVG and the patient was managed successfully by conservative measures.

Conservative management of gastric emphysema with hepatoportal venous gas

“…While this patient's history of active substance abuse and evidence of HPVG were concerning for emphysematous gastritis, his haemodynamic stability and rapid symptomatic resolution was more consistent with a viral gastroenteritis 2. Severe vomiting may cause a mucosal tear, leading to coffee-ground emesis.…”

Gastroduodenal Emphysema with Portal Venous Air due to Congenital Duodenal Web in a Child: A Case Report and Review of Literature

“…It is believed that following the mucosal damage, air tracking through tissue planes enter portal veins leading to portal venous air. Although portal venous air is historically considered to be an ominous sign, this had been described in more benign conditions like gastric outlet obstruction [8,9].…”

“…In the literature, gastric emphysema is classified into two types, viz., emphysematous gastritis and gastric emphysema. It is important to differentiate these two entities as gastric emphysema has a benign self-limiting course, whereas emphysematous gastritis has more grievous course, which needs prompt intervention [8,16,17]. Radiologically, it is often difficult to differentiate the two entities and the differentiation is mainly based on the clinical presentation [1].…”

“…Portal venous air is very rarely associated with gastroduodenal emphysema [8,9]. Even though portal venous air is usually considered as an ominous imaging finding, it could also have benign aetiologies [8,9].…”

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

“…However, if patients are haemodynamically unstable and signs of acute abdomen are present, then immediate surgical exploration is warranted. In cases where clinical presentation and radiological findings remain inconclusive, it is better to perform urgent endoscopy or diagnostic laparoscopy 12. Follow-up CT scan usually shows resolution of air in 3–4 days suggesting a favourable prognosis of gastric emphysema even with the presence of hepatic portal venous gas in uncomplicated individuals 13.…”