Emphysematous Gastritis Due to Infection from a Non Gas-Producing Bacteria!

Abstract

FigurePurpose: Emphysematous gastritis is a rare condition in which gas collects within the stomach wall secondary to infection by gas-producing bacteria. We report the case of 25 year old female with neurofibromatosis who developed diffuse abdominal pain and distension after C-section. There was no history of alcohol or substance abuse, ingestion of corrosive substances or NSAIDs. Patient was febrile, tachycardic, and tachypneic and appeared toxic. Abdomen was markedly distended and tender with absent bowel sounds. Blood work showed WBC count of 25,000 with 91% neutrophils. CT of the abdomen showed gastric pneumatosis along the entire greater curvature and biliary tree, diffuse dilatation of the stomach, small bowel and large bowel. EGD showed diffuse severe mucosal abnormality with congestion, discoloration, granularity, texture change, decreased vascular pattern and ulceration on the posterior wall and greater curvature of the stomach. Gastric biopsy revealed transmural necrosis and streptococcus viridans and stomatococcus were isolated. Patient was started on clindamycin and piperacillin/tazobactam as well as IV hydration and TPN from the first day. Patient improved with the above measures and was discharged home after 10 days of hospital stay. Follow up CT scan and EGD showed resolution of the previous findings. It is important to differentiate emphysematous gastritis from gastric emphysema as early institution of antibiotic therapy covering anaerobes and gram negative bacilli, along with IV hydration and institution of nutrition is the mainstay of treatment. The stomach is a very uncommon site of involvement, due to abundant blood supply, acidity and efficient mucosal barrier. Currently, CT is the best imaging study for diagnosis of emphysematous gastritis. Surgery is avoided during the acute phase of infection due to friability of the gastric mucosa.[figure1][figure2]Figure