Junaid Mir, MD1, Jatinder Goyal, MD2 1Wellspan York Hospital, York, PA; 2Wellspan, York, PA
Introduction: Gastric pneumatosis is defined as intramural gas in the stomach. There are two diseases associated with gastric pneumatosis. There are only 42 reported gastric emphysema cases, while 40 reported cases of emphysematous gastritis are in the literature.Gastric emphysema is a benign finding with an excellent prognosis,while emphysematous gastritis is a catastrophic finding with a mortality rate of 61%.We describe a case of a patient presenting with gastric pneumatosis.
Case Description/Methods: A 74-year-old female presented with complaints of abdominal pain, nausea, and vomiting. Past medical history was significant for gastritis and diffuse large B cell lymphoma in remission. Physical exam was unremarkable except for diffuse abdominal tenderness. Lab tests were unremarkable except for leukocytosis. Blood cultures and urine cultures were negative. CT abdomen showed gastric wall thickening and intramural air in the stomach wall (Fig 1). She was made NPO and started on I/v fluids and broad-spectrum antibiotics. Her abdominal pain resolved with the resolution of leukocytosis. Repeat CT abdomen after three days of her admission showed the resolution of intramural air in the wall of the stomach. She completed the antibiotics for five days and was eventually discharged.
Discussion: This case signifies the importance of recognizing intramural air in the stomach on imaging study of the abdomen. Gastric pneumatosis can be due to gastric emphysema or emphysematous gastritis. Clinical presentation and management of gastric emphysema and emphysematous gastritis are different from each other. Gastric emphysema can be due to traumatic disruption of the mucosa of the stomach, pulmonary trauma, or gastric outlet obstruction. Patients with gastric emphysema are hemodynamically stable and can be managed conservatively with bowel rest, I/v fluids, and antibiotics. Emphysematous gastritis is due to the growth of gas-producing bacteria in the stomach and clinically manifests with hemodynamic instability, lactic acidosis, and severe abdominal pain. Treatment of emphysematous gastritis is complete bowel rest and antibiotics. If medical management fails, then emergent surgery is needed. We hypothesize our patient developed gastric emphysema due to vomiting that might have caused gastric mucosal disruption resulting in intramural gas in the stomach. Clinicians should keep the differential diagnosis in their minds while managing gastric pneumatosis.
Figure: Gastric pneumatosis (fig 1)
Disclosures: Junaid Mir indicated no relevant financial relationships. Jatinder Goyal indicated no relevant financial relationships.
Junaid Mir, MD1, Jatinder Goyal, MD2. P2064 - Gastric Pneumatosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.