Emphysematous gastritis.

Abstract

Emphysematous gastritis is a type of phlegmonous gastritis in which gas is found in the wall of the stomach. There are only twelve reported cases in the literature, the first described by Fraenkel in 1889 (7). An insult to the stomach usually precedes the development of this disease. The mechanisms of insult reported have been ingestion of corrosives (1, 6, 9, 15, 16), gastroenteritis (5, 7, 8, 10, 17), gastroduo-denal surgery (8, 12), and gastric infarction (3). The first roentgenographic diagnosis was made by Weens in 1946 (16). While the disease is rare, the roentgenographic features are sufficiently characteristic that an accurate diagnosis can be made. The most distinctive radiographic feature of emphysematous gastritis on the plain film is the demonstration of gas within the wall of the stomach. This may appear within the first few days of illness and persist up to one month. The intramural gas maintains a constant relationship to the stomach with changes in position of the patient. It may be visible as bubbles of varying sizes, short wide streaks, or amorphous collections. The wall of the stomach is thickened, as seen by a widened soft-tissue shadow, and the rugal folds are frequently swollen. If examination is performed with contrast medium during the acute phase of illness, a water-soluble agent should be used, because of the possibility of perforation and leakage of barium into the peritoneal cavity. Upper gastrointestinal study confirms the extraluminal location of the gas and may reveal a cobblestone appearance of the mucosa due to submucosal blebs. Irregularly widened rugal folds and thickening of the gastric wall are usually demonstrated. Intramural penetration of contrast medium is often seen in the stomach and may also be observed in the duodenum. If the patient survives the acute illness, stricture of the stomach almost invariably occurs (8, 15, 16). If a corrosive agent has been ingested, esophageal stricture may also result (4, 13, 16). Another complication may be esophageal or gastric sinus tract formation. Three cases of emphysematous gastritis following ingestion of corrosives have been seen at Los Angeles County General Hospital and form the basis of this report. Case Reports CASE I: R. B., a 58-year-old Caucasian male, was admitted to the Los Angeles County General Hospital on Feb. 7, 1963, after ingestion of 4 ounces of household ammonia. He complained of pain on swallowing, generalized abdominal pain, and vomited small amounts of blood. On examination, he exhibited oral ulcers and epigastric and right upper quadrant abdominal tenderness. Olive oil and milk were given orally, and the patient was transfused. On the third hospital day, distention and upper abdominal rigidity were noted. Abdominal radiographs at this time revealed a paralytic ileus pattern and a widened soft-tissue shadow between the greater curvature of the stomach and the transverse colon, interpreted as possible pancreatitis.