A 54-year-old female with HIV, diabetes, and chronic obstructive pulmonary disease (COPD) presented with altered mental status, diabetic ketoacidosis, nonspecific gastrointestinal symptoms, and a buttock abscess. Initial abdominal and pelvic computed tomography (CT) without contrast demonstrated a small pericardial effusion, air in the gastric wall, and perianal abscess. Amid worsening leukocytosis (22.500/mm3), a wide excisional debridement of abscess was performed and later repeated. CT angiography of the chest demonstrated a markedly distended stomach with small amount of portal venous air (Figure 1). Abdominal X-ray of the kidney, ureters, and bladder (KUB) demonstrated a distended stomach with wall emphysema and gas collection within the gluteal region (Figure 2).
Esophagogastroduodenoscopy (EGD) revealed black eschars and exudates in the stomach body and fundus (Figure 3). When gastric wall air is present, emphysematous gastritis—with a mortality rate of 50–80%—must be properly distinguished from the more common and less devastating gastric emphysema.1,2 Air within the gastric wall, together with portal venous air, leukocytosis, and a source of infection all support the diagnosis of emphysematous gastritis.3,4 Without evidence of sepsis or ischemia, surgical intervention was not indicated. Conservative management with bowel rest, parenteral nutrition, and broad-spectrum antibiotics was successful.5 The role of endoscopy in cases like this is strictly to monitor severity, identify gastric necrosis, and exclude other pathology.
Author contributions: All authors contributed to evaluating and managing the case and to writing the manuscript. AC Berry is the article guarantor.
Financial disclosure: No financial support or conflicts of interest to report.
Informed consent was obtained for this case report.
Correspondence: Andrew C. Berry, Kansas City University of Medicine and Biosciences, 1750 E. Independence Ave. Kansas City, MO 64106 (ABerry@kcumb.edu).
Received: November 18, 2013; Accepted: March 16, 2014
- Iannuzzi J, Watson TJ, Litle VR. Emphysematous gastritis: A young diabetic’s recovery. Int J Surg Case Rep. 2012;3(4):125–7. Article | PubMed
- Yalamanchili M, Cady W. Emphysematous gastritis in a hemodialysis patient. South Med J. 2003;96(1):84–8. Article | PubMed
- Kussin SZ, Henry C, Navarro C, et al. Gas within the wall of the stomach: Report of a case and review of the literature. Dig Dis Sci. 1982;27(10):949–54. Article | PubMed
- Loi TH, See JY, Diddapur RK, Issac JR. Emphysematous gastritis: A case report and a review of literature. Ann Acad Med Singapore. 2007;36(1):72–3. PubMed
- Szuchmacher M, Bedford T, Sukharamwala P, et al. Is surgical intervention avoidable in cases of emphysematous gastritis? A case presentation and literature review. Int J Surg Case Rep. 2013;4(5):456–9. Article | PubMed
© 2014 Murchie et al. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0.