Early total gastrectomy in emphysematous gastritis

Abstract

AbstractEmphysematous gastritis is a rare form of lethal infection caused by gas‐forming organisms arising from local spread through the gastric mucosa or hematogenous dissemination from a distal focus. It is the counterpart of ischemic bowel disease happening in the stomach. No definitive mode of treatment has been advocated despite its high mortality. Thus far, only 41 cases have been reported in the literature since Dr. Frankel first reported it in 1889. To further understand the disease, we present a case of emphysematous gastritis in a 74‐year‐old female uremic patient, further afflicted with diabetes mellitus, chronic decubitus ulcers, and peripheral occlusive arterial disease, manifesting with fever and sudden loss of consciousness without physical signs of peritonitis. She was diagnosed via computed tomography scan, which showed pneumatosis around the stomach wall, pneumoporta, and pneumoperitoneum. She underwent total gastrectomy within 24 hours, revealing edematous gastric wall and hemorrhagic necroses over the fundus and antrum. Postoperatively, she gradually improved with respirator support, total parenteral nutrition, and broad‐spectrum antibiotics, and she was discharged after 33 days of hospitalization without anastomotic leaks. Further follow‐up revealed that she survived for one and a half years following her surgery without developing a new intra‐abdominal incident, albeit with frequent hospitalizations due to her continuing chronic medical problems. Early aggressive total gastrectomy may be tried to reverse the morbid course of the disease.