Gastric Pneumatosis and Acute Massive Gastric Dilatation without Specific Cause

Abstract

A 53-year-old man presented to the Emergency Department (ED) with a chief complaint of 15 h of abdominal distension and vomiting. He had a history of hypertension but had not undergone any surgeries. On presentation he was alert with the following vital signs: blood pressure, 140/100 mm Hg; heart rate, 100 beats/ min; respiratory rate, 20 breaths/min; and body temperature, 36 C. Bowel sounds were absent and no tenderness was noted. Blood sampling results were as follows: white blood cells, 23.4 10/mm; hemoglobin, 15.2 g/dL; normal platelet count; normal electrolyte levels; and serum creatinine, 1.6 mg/dL. Urine analysis was positive for glucosuria and hematuria. Massive gastric dilatation was observed on a plain abdominal film (Figure 1). Intravenous fluid replacement was initiated and a nasogastric tube was inserted, which drained 1500 cc of dark-brown fluid in 5 h. Vital signs after drainage were: blood pressure, 180/100 mm Hg; heart rate, 140 beats/min; and respiratory rate, 26 breaths/ min. No abdominal pain or fever was observed. The patient’s symptoms had not improved, and further diagnostic modalities were ordered. An abdominal computed tomography (CT) scan revealed gastric pneumatosis (GP), along with diffuse gas in the hepatoportal, splenic, and intrahepatic portal vein,