Emphysematous gastritis associated with severe vascular disease

Abstract

Introduction: Emphysematous gastritis is a rare form of gastritis that results from infection of the stomach wall by gas-forming organisms. Diagnosis of emphysematous gastritis is based on the clinical presentation of an acute abdomen with systemic toxicity and on radiographs/CT scans demonstrating gas bubbles within the stomach wall. Only by prompt diagnosis and treatment can mortality be avoided. Clinical Picture: We present a 51-year-old African American female who developed severe abdominal pain following exploration of femoral artery for a repair of pseudoaneurysm. CT scans revealed linear gas densities within the thickened gastric wall and portal venous air. Treatment: The patient was started on broad-spectrum antibiotics and taken to the operating room for exploration, and she underwent a total gastrectomy with Roux-en-Y esophageal jejunostomy reconstruction. Outcome: She responded well and was discharged home. Conclusion: The optimal therapy has not been defined; however, antimicrobial chemotherapy and surgery, when appropriate, may improve survival rates.