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An 89-year-old woman who had type 2 diabetes mellitus and chronic kidney
disease had been admitted to our hospital for rehabilitation. She
suddenly presented with abdominal pain, vomiting, and hypotension.
Abdominal computed tomography showed thickening of the wall and
intramural gas in the gastric hilum, suggesting emphysematous gastritis,
along with portal gas in the left lobe of the liver (Fig. 1A). The
patient underwent treatment with a proton pump inhibitor, and
broad-spectrum antibacterial agents. Blood cultures taken prior to the
initiation of antimicrobial therapy were negative. Two weeks after the
onset, endoscopy showed post-hemorrhagic changes in the gastric mucosa
on the upper gastric bends (Fig. 1B). The patient gradually recovered,
resumed oral intake, and was discharged.
Emphysematous gastritis is caused by gas-producing bacteria, the
mortality rate has been reported to be 55.3% (1). As in our case,
diabetes mellitus, malnutrition, and renal failure are risk factors for
the disease (1). Although it is important to differentiate it from
gastric emphysema, cystic emphysema in the gastric wall is a
characteristic of emphysematous gastritis on a CT scan (2). When a
patient with the above-mentioned risk factors has sudden abdominal pain,
emphysematous gastritis should be included in differential diagnosis.
Key words: emphysematous gastritis; phlegmonous gastritis;
portal venous gas.
Funding: None to report.
Disclosure: The authors state that there are no conflicts of
interest to declare.
Authors’ Contribution: RT: wrote the first draft and managed
all the submission process. NF and OS: contributed to the clinical
management of the patient. HH: organized writing the manuscript.