INTRODUCTION: Emphysematous gastritis (EG) is a rare and often fatal disorder involving infection of the gastric wall by gas-forming organisms. PRESENTATION OF CASE: We present the case of a 25-year-old diabetic man with severe gastroparesis, who complained of vomiting and right upper quadrant pain. The surgical consultant exam in the emergency department revealed a tender but not acute abdomen. On abdominal computed tomographic imaging, there was gas throughout the wall of the stomach but no evidence of gastric perforation. The patient was treated non-operatively with antibiotics, bowel rest, serial abdominal exams, and upper endoscopy (EGD). DISCUSSION: EG has been associated with overall mortality rates exceeding 50%. Early recognition and administration of antibiotics is essential to reduce mortality risk. Indications for laparotomy include perforation or uncontrolled sepsis. CONCLUSION: EG can occur in diabetics with gastroparesis complicated by a bezoar and hyperemesis. Gastric pneumatosis is not an absolute indication for celiotomy as antibiotics and surgical vigilance may be appropriate and curative therapy. Copyright Â
INTRODUCTION:Emphysematous gastritis (EG) is a rare and often fatal disorder involving infection of the gastric wall by gas-forming organisms. PRESENTATION OF CASE: We present the case of a 25-year-old diabeticman with severe gastroparesis, who complained of vomiting and right upper quadrant pain. The surgical consultant exam in the emergency department revealed a tender but not acute abdomen. On abdominal computed tomographic imaging, there was gas throughout the wall of the stomach but no evidence of gastric perforation. The patient was treated non-operatively with antibiotics, bowel rest, serial abdominal exams, and upper endoscopy (EGD). DISCUSSION: EG has been associated with overall mortality rates exceeding 50%. Early recognition and administration of antibiotics is essential to reduce mortality risk. Indications for laparotomy include perforation or uncontrolled sepsis. CONCLUSION: EG can occur in diabetics with gastroparesis complicated by a bezoar and hyperemesis. Gastric pneumatosis is not an absolute indication for celiotomy as antibiotics and surgical vigilance may be appropriate and curative therapy. Copyright Â
Authors: Amit Merchea; Daniel C Cullinane; Mark D Sawyer; Corey W Iqbal; Todd H Baron; Dennis Wigle; Michael G Sarr; Martin D Zielinski Journal: Surgery Date: 2010-08-14 Impact factor: 3.982