2693 Gastric Emphysema: A Complication of Intractable Vomiting

Abstract

INTRODUCTION: Gastric pneumatosis is a term used to describe gas within the wall of the stomach. It is due to either one of two causes: emphysematous gastritis or gastric emphysema. The latter carries a better prognosis and is generally characterized by hemodynamic stability and spontaneous resolution with conservative management8. CASE DESCRIPTION/METHODS: A 58 year old female presented to the hospital with dyspnea and vomiting. Past medical history included coronary artery disease and diabetes mellitus type II. She was found to have a non-ST elevation myocardial infarction which was treated medically. Because of persistent vomiting, a gastroenterology consultation was requested. Physical examination at the time of consultation revealed an obese female with stable vital signs and a moderately distended abdomen. Laboratory tests revealed white blood cell count: 13.7 10 × 3/uL, hemoglobin 12.4 g/dL, lactic acid 1.0 mmol/L, lipase 30 U/L, and amylase 52 U/L. Computed tomography (CT) scan of the abdomen/pelvis was performed and revealed diffuse wall thickening of the stomach and a large amount of intramural air, particularly involving the fundus. Based on her symptoms and radiological findings, the diagnosis of gastric emphysema was made and she was treated with conservative measures. Her symptoms improved and a repeat CT scan of the abdomen ten days later failed to reveal any gastric pneumatosis. DISCUSSION: Gastric emphysema is benign and managed with observation and conservative treatment. Patients are hemodynamically stable without any associated infection3,8 The cause of either gastric emphysema or emphysematous gastritis can be due to an increase in intraluminal pressure or a mucosal injury that leads to intramural gas formation. Mucosa may be compromised in patients who are on immunosuppressive/cytotoxic therapy or in those patients who suffer from autoimmune and inflammatory diseases7. Diagnosis of gastric pneumatosis is made using CT imaging6 which can detect small amounts of gas in the stomach wall.3,5 Treatment for gastric pneumatosis includes supportive care. This includes adequate bowel rest and fluid support as needed. Surgical intervention or antibiotic therapy may be needed in certain cases of emphysematous gastritis5. In our patient, we suspect her development of gastric emphysema was due to her intractable nausea and vomiting. As in the majority of cases, her symptoms improved with conservative treatment and follow-up radiological imaging revealed resolution of her findings.