CHSU Discovery

Abstract:

Introduction: Emphysematous gastritis, characterized by air within the stomach wall due to gas-producing organisms, presents with symptoms of abdominal distention, tenderness, and acute abdomen bearing a high mortality rate of 60-80%. Conversely, gastric emphysema is a benign non-infectious gastric pneumatosis that can resemble emphysematous gastritis, posting diagnostic challenges. 

Case Presentation: Patient is an 87-year-old female with diabetes admitted to the emergency room for hypoglycemia and decreased oral intake. Physical examination revealed a soft, mildly distended abdomen without tenderness. Laboratory findings indicated leukocytosis (WBC 11.1) and severe hypoglycemia (glucose 32 mg/dL). CT imaging showed severe emphysematous gastritis with air within the stomach wall and droplets outside, accompanied by pneumoperitoneum, severe gastric wall edema, pneumobilia, and air in the pancreatic duct. 
The patient was admitted for emphysematous gastritis. Consultation with general surgery and gastroenterology favored conservative management. The patient received IV fluids (Zosyn), bowel rest, pantoprazole. After 48 hours, diet was reintroduced. Patient had overall significant improvement and was discharged without complication. 

Discussion: Despite this patient’s benign hospital course, the possibility of emphysematous gastritis remained significant given the mortality risk associated with it. Literature review supports conservative management for emphysematous gastritis with IV fluids, bowel rest, and broad-spectrum antibiotics unless complications such as perforation arise, necessitating surgical intervention. Various factors predispose to disrupted gastric integrity and subsequent gas-forming infection, including NSAID use, uncontrolled diabetes mellitus, malignancy, gastroenteritis, recent abdominal surgery, and steroid use. In this case, diabetic gastroparesis might have heightened the risk of bacterial translocation and gastrointestinal infection. 
Although the patient lacked fever, acute abdomen, or bacteremia, the diagnosis of emphysematous gastritis couldn't be ruled out definitively. The high mortality of emphysematous gastritis underscores the importance of early identification for prompt intervention with aggressive conservative treatment, despite the possibility of a less severe condition like gastric emphysema.