Ganesh Arun, DO, Emily Rey, DO, David Rayne, MD, Jennifer Huber, DO, Thomas Taylor, MD, Farhan Ali, DO Arnot Health, Elmira, NY
Introduction: Emphysematous gastritis (EG) is a rare condition defined by air within the gastric wall with systemic manifestations. The culprit organisms that produce these gases are Streptococcus species, Escherichia coli, and Enterobacter species. Risk factors include malignancy, recent surgery, bowel obstruction, steroids, chemotherapy, and alcohol. This is a case of a 70 year old gentleman showcasing surgical involvement with complications of emphysematous gastritis.
Case Description/Methods: A 70 year old gentleman with a past medical history of peptic ulcer disease and hypertension presented with hematemesis and melena for the past several days. Noticed black, tarry stools requiring endoscopy and revealed a 3 cm ulcer of the gastric lesser curvature with arterial bleed. Treated at the time with epinephrine injection and BICAP cauterization which was complicated by hypotension. Interventional Radiology conducted a visceral angiogram. His left gastric artery was noted to have a separate origin as a proximal branch off the aorta. His bleeding persisted during his inpatient stay, and he was noted to have extensive air within the thickened gastric wall on CT scan, concerning emphysematous gastritis. He required partial gastrectomy with lysis of adhesions and exploratory laparotomy. He improved following intervention and was eventually discharged with instructions to continue pantoprazole and proton pump inhibitor, indefinitely.
Discussion: The emphysematous pressure and location of this air impacts extra-intestinal systems. Diagnosis is primarily established on CT scan by intramural air in the stomach. Early recognition and treatment are key to prevent complications unlike this case. The differential includes Emphysematous Gastritis which should be differentiated from Gastric Emphysema (GE) due to identical radiographic images. GE is a relatively benign condition secondary to barotrauma without any signs of infection or systemic involvement.
The initial management is proton pump inhibitor, intravenous fluids, and antibiotics. Decompression may be necessary in the setting of gastric distension on imaging, persistent emesis, and concern for bleeding. Surgical exploration is only reserved for cases that fail non-operative management, or develop complications of peritonitis and bleeding. This review explored the surgical management with complications of emphysematous gastritis.
Figure: CT of the Abdomen and Pelvis shows diffuse wall thickening, low attenuation, and foci of air involving the gastric wall, concerning for emphysematous gastritis.
Disclosures: Ganesh Arun indicated no relevant financial relationships. Emily Rey indicated no relevant financial relationships. David Rayne indicated no relevant financial relationships. Jennifer Huber indicated no relevant financial relationships. Thomas Taylor indicated no relevant financial relationships. Farhan Ali indicated no relevant financial relationships.
Ganesh Arun, DO, Emily Rey, DO, David Rayne, MD, Jennifer Huber, DO, Thomas Taylor, MD, Farhan Ali, DO. P2070 - A Rare Case of Emphysematous Gastritis: When Medical Management Wasn't Enough, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.