A 68‐year‐old man with known esophageal peptic stenosis, end‐stage renal disease, ischemic cardiomyopathy, severe peripheral vascular disease, and diabetes mellitus with gastroparesis presented to the emergency department with dull upper abdominal pain and recurrent nausea and vomiting with hematemesis. A nasogastric tube was inserted and confirmed coffee‐ground emesis within the stomach. The patient was a chronically ill appearing man who was afebrile but mildly hypotensive. The abdominal examination revealed epigastric tenderness. Laboratory data revealed a white blood cell count of 31,000 mm3 and hemoglobin of 10 g/dL. An abdominal x‐ray revealed an unusual gas pattern in the stomach. A CT scan of the abdomen was obtained and revealed gastric pneumatosis extending into the esophagus. Portal venous gas was present as well. Endoscopy was performed and revealed necrotic mucosa with sloughing. Surgical and infectious disease consultations were requested and conservative treatment with broad coverage antibiotics, bowel rest and total parenteral nutrition was recommended. Intravenous pantoprazole was also used. The patient clinically improved and a repeat CT scan revealed near resolution of the gastric pneumatosis and portal venous gas. The patient continued to stabilize and was discharged 2 weeks after he was admitted.
Emphysematous gastritis is a rare but potentially lethal variant of phlegmonous gastritis. This condition has been associated with peptic ulcer disease, alcohol abuse, corrosive ingestions, NSAIDS, diabetes mellitus, abdominal surgery, inflammatory bowel disease, ischemia and immunocompromised states. However, a local bacterial infection with a gas‐forming microorganism was suspected in this case in spite of negative culture results. Portal venous gas was present on the abdominal CT scan along with gastric pneumatosis. In 1 study with this finding the mortality was very high, and most patients required surgical intervention.
A case of emphysematous gastritis with portal venous gas is presented. The patient was considered to be a high operative risk and was treated successfully with conservative medical management. Early recognition of this condition and prompt treatment allowed optimal therapy obviating the need for surgery required in many of these cases.
To cite this abstract:College D. A Case of Emphysematous Gastritis: A Potentially Fatal Disease. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 405. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/a-case-of-emphysematous-gastritis-a-potentially-fatal-disease/. Accessed May 26, 2019.