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Case Reports
. 2024 Aug 3;16(8):e66084.
doi: 10.7759/cureus.66084. eCollection 2024 Aug.

A Case of Haemorrhagic Emphysematous Gastritis

Hussein Mansour  1 , Jawad Ali  1 , Anupama Swamy  2 , Anthony Leahy  1
Affiliations
Case Reports

A Case of Haemorrhagic Emphysematous Gastritis

Hussein Mansour et al. Cureus. .

Abstract

Emphysematous gastritis is a rare condition with a high mortality rate. We present a rare case of haemorrhagic emphysematous gastritis in a 70-year-old woman with a background of relapsed endometrioid ovarian cancer previously treated with chemotherapy and recent prednisolone use. A CT scan showed a grossly distended stomach with gas in the stomach wall and gas in the gastric and portal veins in the liver. The duodenum and small bowel were not dilated, suggesting gastric outlet obstruction potentially secondary to serosal deposits. Endoscopic evaluation showed an ischaemic oesophagus and posterior wall of the stomach, with necrosis of the greater curve. Histology showed complete loss of the gastric epithelium along with transmural necrosis along with intense acute and chronic inflammation. She was treated conservatively, as she was not fit for surgery due to her co-morbidities. She symptomatically improved and was discharged under the palliative care team. There are no current clear guidelines on treatment approaches. After a patient is haemodynamically stabilised, treatment options currently include surgical intervention (gastrectomy) or conservative options (fluid resuscitation, nasogastric decompression, broad-spectrum antibiotics/antifungals and supportive management). Historically, emphysematous gastritis was conventionally managed surgically. There has been a shift towards conservative management in recent literature, reporting good patient outcomes in patients successfully managed without surgical intervention.

Keywords: case report; chemotherapy; emphysematous gastritis; gastric emphysema; pneumatosis intestinalis.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Coronal CT imaging demonstrating a grossly distended stomach with air in the portal venous system (red arrows in A and B); cross-sectional CT imaging showing air in the gastric wall (yellow arrows in B and C)
Figure 2
Figure 2. OGD images showing blood (yellow arrow); the entire posterior wall of the stomach appears ischaemic (white arrow) with necrotic black regions (blue arrow) on the greater curve
OGD: oesophagogastroduodenoscopy
Figure 3
Figure 3. Ulcerated, necrotic, and intensely inflamed gastric mucosa with congestion and oedema
H&E; magnification x100
See this image and copyright information in PMC

References

    1. Emphysematous gastritis and gastric emphysema: similar radiographic findings, distinct clinical entities. Matsushima K, Won EJ, Tangel MR, Enomoto LM, Avella DM, Soybel DI. World J Surg. 2015;39:1008–1017. - PubMed
    1. The predictors of mortality and secular changes in management strategies in emphysematous gastritis. Watson A, Bul V, Staudacher J, Carroll R, Yazici C. Clin Res Hepatol Gastroenterol. 2017;41:0–7. - PubMed
    1. A rare case of emphysematous gastritis secondary to chemotherapy. Ogbue OD, Haddad A, Daw H. Cureus. 2021;13:0. - PMC - PubMed
    1. Emphysematous gastritis in a hemodialysis patient. Yalamanchili M, Cady W. South Med J. 2003;96:84–88. - PubMed
    1. Emphysematous gastritis: A case series of three patients managed conservatively. Nasser H, Ivanics T, Leonard-Murali S, Shakaroun D, Woodward A. Int J Surg Case Rep. 2019;64:80–84. - PMC - PubMed

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