Gastric Emphysema Associated with Diabetic Gastroparesis: A Case Report

Abstract

Purpose: Case report: A 21 yr old Caucasian male with history of type 1 diabetes mellitus was admitted with complaints of persistent vomiting and abdominal pain for 2 days. Laboratory work done revealed diabetic ketoacidosis, presumably secondary to non compliance. The patient was treated with intravenous fluids and insulin. The anion gap normalized. However, he was not able to tolerate a liquid diet. Clinical examination revealed a slightly distended abdomen and positive bowel sounds. Radiological investigations revealed air in the gastric wall. He was then continued on supportive management and nasogastric suction which led to gradual improvement in his condition. Upper GI endoscopic biopsy revealed gastritis and gastric emptying study done later showed severe gastroparesis. Discussion: The appearance of gas within the wall of the stomach is an extremely rare occurrence. It can be infectious (emphysematous gastritis) or noninfectious (gastric emphysema). It has a high mortality of 43% in adults. Gastric emphysema, by definition is benign and generally due to forceful entry of gas into the stomach wall via a mucosal tear, or as a result of mediastinal air passing retroperitoneally into the gastric wall. Acute gastric dilatation consequent to obstructed gastric outlet seems to be the commonest cause, followed by instrumentation. Most cases are preceded by vomiting which when accompanied with marked gastric distension could result in air entry into the submucosa of the gastric wall. To the best of our knowledge, severe gastroparesis, as in our case has not been reported to be associated with gastric emphysema. Gastric emphysema is best diagnosed by CT scan, demonstrating the presence of gas bubbles along the greater curvature. Treatment is generally supportive with nasogastric suction resulting in gradual improvement. Emphysematous gastritis is associated with a much more ominous clinical course and usually requires aggressive management with antibiotics and surgery in most cases. This research was supported by an industry grant from This is a case report. Hence not applicable.Figure: CT scan of the abdomen demonstrating radiolucencies along the greater curvature of the stomach.