Abstract
IntroductionEmphysematous gastritis (EG) is a rare condition characterized by air within the gastric wall with signs of systemic toxicity. The optimal management for this condition and the role of surgery is still unclear. We here report three cases of EG successfully managed non-operatively. Presentation of casesAll three of our patients were elderly females with several co-morbidities. The chief presenting symptom was abdominal pain with signs of systemic toxicity ranging from tachycardia and hypotension to acute kidney injury. Computed tomography (CT) scan revealed gastric pneumatosis in all patients. One patient had extensive portal venous gas, and another had free intraperitoneal air. All patients were managed with nothing by mouth, proton pump inhibitors, intravenous fluid resuscitation, and antibiotics. Repeat CT scan in two patients in 3–4 days demonstrated resolution of the pneumatosis. They were all discharged home tolerating an oral diet. DiscussionThe presentation of EG is non-specific and the diagnosis is primarily established by findings of intramural air in the stomach on CT scan. The initial management of EG should be nothing by mouth, proton pump inhibitor, intravenous fluid resuscitation, and antibiotics with surgical exploration only reserved for cases that fail non-operative management, demonstrate clinical deterioration, or develop signs of peritonitis. ConclusionEarly recognition and initiation of appropriate therapy is crucial to prevent the progression of EG. EG, even in the presence of portal venous air or pneumoperitoneum, should not represent a sole indication for surgical exploration and trial of initial non-operative management should be attempted when clinically appropriate.
Highlights
Emphysematous gastritis (EG) is a rare condition characterized by air within the gastric wall with signs of systemic toxicity
Computed tomography (CT) scan of the abdomen without contrast was obtained to evaluate her abdominal pain and revealed gastric distension with gastric pneumatosis (Fig. 1). She was treated for EG with nasogastric tube (NGT) decompression, intravenous fluid resuscitation, nil per os (NPO), antibiotics, and proton pump inhibitor (PPI)
In the cases we reported, only the second patient had a clear inciting event which was most likely an acute congestive heart failure (CHF) exacerbation with a low flow state
Summary
Emphysematous gastritis (EG) is a rare condition characterized by air within the gastric wall with signs of systemic toxicity. All patients were managed with nothing by mouth, proton pump inhibitors, intravenous fluid resuscitation, and antibiotics. Repeat CT scan in two patients in 3–4 days demonstrated resolution of the pneumatosis. They were all discharged home tolerating an oral diet. The initial management of EG should be nothing by mouth, proton pump inhibitor, intravenous fluid resuscitation, and antibiotics with surgical exploration only reserved for cases that fail non-operative management, demonstrate clinical deterioration, or develop signs of peritonitis. EG, even in the presence of portal venous air or pneumoperitoneum, should not represent a sole indication for surgical exploration and trial of initial non-operative management should be attempted when clinically appropriate
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