A Rare Case of Emphysematous Gastritis Secondary to Chemotherapy

Abstract

Emphysematous gastritis is a rare medical condition characterized by the presence of intra-mural air in the stomach associated with portal venous air tracking to a variable degree. There are no established guidelines favoring surgery over medical management. We present a case of a 64-year-old Caucasian male with a history of stage four colon adenocarcinoma with peritoneal carcinomatosis, malignant ascites, and liver metastasis status post-three cycles of chemotherapy who presented to the emergency room with complaints of generalized abdominal pain, nausea, non-bilious vomiting, and melena stools. He was managed conservatively as a case of sepsis secondary to emphysematous gastritis and made a full recovery. To our knowledge, this is the first reported case of emphysematous gastritis in an adult with colon cancer. Although we cannot establish a causal link between his chemotherapy regimen and emphysematous gastritis, the combined effect of an immunosuppressive state caused by advanced malignancy and cytotoxic effects of chemotherapy are the probable risk factors in our patient. We described the possible mechanisms of mucosal disruption by fluorouracil and bevacizumab in our case. Despite historically having a poor prognosis, emphysematous gastritis can be managed conservatively on a case-by-case basis. Clinicians should be aware that chemotherapy can be a predisposing factor to developing this rare condition.

Keywords: bevacizumab; chemotherapy; colon adenocarcinoma; emphysematous gastritis; fluorouracil.

Figure 1. Coronal sectional view of the CT scan of the abdomen showing gas within the wall of the stomach. Arrow demonstrating intra-mural gastric air.

Figure 2. Cross-sectional view of the same contrast-enhanced CT scan of the abdomen demonstrating portal venous air.

Figure 3. Mechanism of mucosal injury from effects of chemotherapy and malignancy.

fdUMP: fluorordeoxyuridylate, 5-FU: 5-fluorouracil.