Emphysematous gastritis in an immunocompromised host

The predictors of mortality and secular changes in management strategies in emphysematous gastritis

“…The pathognomonic finding of emphysematous gastritis is emesis of a necrotic mucosal clot in the shape of the gastric wall caused by dissection of the muscularis mucosa by bacterial organisms [1,6,9,10]. Patients with an immunocompromised state such as those with diabetes mellitus, cirrhosis or end-stage renal disease (ESRD) can have less dramatic presentations of the illness [11][12][13].…”

“…Computed tomography (CT) is more sensitive and specific for detecting intramural gas and is better able to delineate its precise anatomical involvement [25]. CT findings classically include cystic pockets or streaks of air within the gastric wall, thickened mucosal folds, pneumoperitoneum [26,12] and portal venous gas [27][28][29][30][31]. Endoscopic findings greatly vary between cases but typically reveal erythematous, erosive lesions with occasional cobblestoning and necrosis of the gastric mucosa.…”

Emphysematous gastritis: A deadly infectious disease

“…CT is more sensitive and specific for detecting abnormal gas and can be used to delineate the anatomic location and extent of the gas more precisely. Characteristic findings include cystic pockets or streaks of air within the gastric wall with thickened mucosal folds, and pneumoperitoneum [4,20], portal venous gas [10,16,17,22,23], and pneumatosis intestinalis are occasionally observed [22]. Our patient presented some unique CT findings.…”

“…However, early recognition of the illness, application of broad-spectrum antibiotics, and meticulous supportive care are regarded as key therapeutic measures. The role of surgery remains uncertain and, in this review, 3 of 5 patients who underwent an emergency total gastrectomy still succumbed to death [4,12,18,20,21]. Thus, current indications for operative intervention should probably be limited to failed medical management, gastric infarction, presence of peritoneal signs, perforation, and extensive involvement of visceral organs [3,12].…”

“…Moosvi et al [3] reported that there was usually a direct insult to the gastric mucosa by a harmful agent in the development of emphysematous gastritis, and acid (37%) and alcohol abuse (21%) were the 2 leading offending substances. However, these 2 factors accounted for only 13% [4Á6] of all the cases since 1990 [4Á24], and instead, risk factors for an immunocompromized state, such as diabetes mellitus (27%) [4,10Á12,17,20], use of immunosuppressives (18%) [13,15,18,20], and dialysis (14%) [12,14,24], played a major role. Evidently, our patient had no history of any of the predisposing factors for emphysematous gastritis.…”