Unexplained Portal Gas in a Patient with an Esophageal Ulcer

Abstract

Emphysematous gastritis is the infection of gastric mucosa by gas producing microorganisms. It is a rare infection with less than 100 cases reported in the literature. The association of portal venous gas along with emphysematous gastritis is a rare entity. The concomitant portal venous gas worsens the outcome and warrant for surgical treatment. Our case has portal venous gas on CT scan along with suspicion of emphysematous gastritis and an esophageal ulcer on upper GI endoscopy. Medical treatment was given in our case of portal venous gas with the esophageal ulcer. Our case is unique because our patient responded to the conservative management. The patient presented with past history of polysubstance abuse and chronic kidney disease presented with symptoms of acute abdomen. CT scan revealed portal venous gas and suspicion of gastric emphysema. In addition, few foci of gas are seen along the vessels traversing between the stomach and liver. Endoscopy with gastric mucosa biopsy showed Candida albicans. Subsequently, antifungals were started. There was improvement in clinical condition of the patient. We, hereby, also summarize all the reported cases of emphysematous gastritis with treatment and outcome in each case. There has been change in trend from surgical to medical treatment.

A Rare Case of Emphysematous Gastritis Secondary to Organo-Axial Gastric Volvulus Associated With Sarcina ventriculi

“…Key imaging features include gastric distention, gastric mucosal wall/fold thickening in the setting of edema, and infiltrating gas within the wall—especially within the fundus and/or greater curvature. 2–5 Changes in body position do not affect these features. 3 Portal venous gas (PVG) can also be present and is a negative prognostic marker as EG mortality exceeds 75% when simultaneously present.…”

“…[1][2][3][4][5][6][7][8][9] It has been proposed that gastric mucosal lesions (either ulcerative or ischemic) may serve as a nidus for penetration and mucosal breakdown vs hematogenous spread from a distant focus, with subsequent gas production. [1][2][3][4][5][6] Typical organisms include Streptococci species, Escherichia coli, Clostridium spp, Klebsiella pneumoniae, and rarely Sarcina ventriculi. 1,2,4,[6][7][8][9][10] Gastric volvulus can compromise blood supply to the stomach and predispose to ischemia and EG.…”

“…[1][2][3][4][5][6] Typical organisms include Streptococci species, Escherichia coli, Clostridium spp, Klebsiella pneumoniae, and rarely Sarcina ventriculi. 1,2,4,[6][7][8][9][10] Gastric volvulus can compromise blood supply to the stomach and predispose to ischemia and EG. We present a rare case of EG associated with S. ventriculi, secondary to organo-axial volvulus of the stomach.…”

Gastric Emphysema and Hepatic Portal Vein Gas as Complications of Noninvasive Positive Pressure Ventilation

“…Immunosuppression due to diabetes, malignancy, alcohol abuse, recent abdominal surgery, ingestion of corrosives, nonsteroidal anti-inflammatory drugs (NSAIDs), blunt abdominal trauma, and severe vomiting represent some of the risk factors that may breach the integrity of the gastric mucosa and, thus, may be associated with an increased risk of bacterial penetration into the stomach wall and the subsequent development of EG [ 4 , 5 ]. Severe abdominal pain, hematemesis, nausea, vomiting, epigastric tenderness, fever, chills, hemodynamic instability, leukocytosis, and lactic acidosis may be observed as presenting features [ 6 ]. CT scan of the abdomen may reveal the presence of air in the gastric wall in a streaky and linear distribution along with thickening of the gastric folds.…”

Emphysematous gastritis

“…6 Gupta listed the treatment and the outcome of 57 case reports published from 1980 to 2018. 7 Therefore, we searched PubMed…”