Case Report

Emphysematous Gastritis in a Hemodialysis Patient

Authors: Madhuri Yalamanchili, MD, William Cady, MD

Abstract

Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated systemic toxicity. We report a case of emphysematous gastritis in a 43-year-old diabetic patient receiving hemodialysis and review 41 cases published since 1889. The most common predisposing factors included ingestion of corrosive substances, alcohol abuse, abdominal surgery, diabetes, and immunosuppression. Diagnosis is based on clinical presentation of acute abdomen with associated features of systemic toxicity. The most commonly involved organisms were streptococci (nine cases), Escherichia coli (nine cases), Enterobacter species (six cases), Clostridium welchii (four cases), and Staphylococcus aureus (four cases). Computed tomography (CT) is the diagnostic procedure of choice. The mortality rate was 61% (25 of 41 patients). Gastric contractures after recovery were noted in 10% (4 of 41 patients). Antimicrobial therapy with antibiotics covering gram-negative organisms and anaerobes, and surgery in appropriate cases may enhance survival.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Fraenkel E: A case of emphysematous gastritis probably of mucormycotic origin [in German]. Virchows Arch A 1889; 118: 526–535.
 
2. Cherney CL, Chutuape A, Fikrig MK. Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: Case report and literature review. Am J Gastroenterol 1999; 94: 252–256.
 
3. Bashour CA, Popovich MJ, Irefin SA, et al. Emphysematous gastritis. Surgery 1998; 123: 716–718.
 
4. Sud A, Lehl SS, Bhasin DK, Deodhar SD. Emphysematous gastritis. Am J Gastroenterol 1996; 91: 604–605.
 
5. Lin CY, Lee CS, Lin DY, et al. Emphysematous gastritis secondary to acute gastric dilatation. J Gastroenterol Hepatol 1995; 10: 612–615.
 
6. Van Allan RJ, Krebs TL, Henzie GM, Fermelia DE, Fichman MP. Emphysematous gastritis in an immunocompromised host. Clin Imaging 1995; 19: 129–130.
 
7. McKelvie PA, Fink MA. A fatal case of emphysematous gastritis and esophagitis. Pathology 1994; 26: 490–492.
 
8. Hadas-Halpren I, Hiller N, Guberman D. Emphysematous gastritis secondary to ingestion of large amounts of Coca Cola. Am J Gastroenterol 1993; 88: 127–129.
 
9. Binmoeller KF, Benner KG. Emphysematous gastritis secondary to gastric infarction. Am J Gastroenterol 1992; 87: 526–529.
 
10. Moosvi AR, Saravolatz LD, Wong DH, Simms SM. Emphysematous gastritis: Case report and review. Rev Infect Dis 1990; 12: 848–855.
 
11. Caruana V, Swayne LC, Salaki JS. Indium-111 WBC detection of emphysematous gastritis in pancreatitis. J Nucl Med 1990; 31: 112–114.
 
12. Monteferrante M, Shimkin P. CT diagnosis of emphysematous gastritis. AJR Am J Roentgenol 1989; 153: 191–192 (letter).
 
13. Williamson MR, Shah HR, Harper RR, Angtuaco TL. CT of emphysematous gastritis. Comput Med Imaging Graph 1989; 13: 175–177.
 
14. Bloodworth LL, Stevens PE, Bury RF, Arm JP, Rainford DJ. Emphysematous gastritis after acute pancreatitis. Gut 1987; 28: 900–902.
 
15. de Lange EE, Slutsky VS, Swanson S, Shaffer HA Jr. Computed tomography of emphysematous gastritis. J Comput Assist Tomogr 1986; 10: 139–141.
 
16. Udassin R, Aviad I, Vinograd I, Nissan S. Isolated emphysematous gastritis in an infant. Gastrointest Radiol 1984; 9: 9–12.
 
17. Williford ME, Foster WL Jr, Halvorsen RA, Thompson WM. Emphysematous gastritis secondary to disseminated strongyloidiasis. Gastrointest Radiol 1982; 7: 123–126.
 
18. Bernardino ME, Lawson TL. Emphysematous gastritis and gastric perforation: An unusual manifestation of alkaline corrosive ingestion. Gastrointest Radiol 1977; 2: 107–108.
 
19. Jensen AR, Rodgers BM. Emphysematous gastritis secondary to acid ingestion in an infant. J Fla Med Assoc 1977; 64: 484–487.
 
20. Rowen M, Myers M, Williamson RA. Emphysematous gastritis in a leukemic child. Med Pediatr Oncol 1976; 2: 433–437.
 
21. Weston TS. Emphysematous gastritis: report of a case. Aust N Z J Surg 1975; 45: 261–262.
 
22. Kinkhabwala MN, Conradi H, Farman J, Rabinowitz JG. Acute emphysematous gastritis: The significance of the angiographic findings. Radiology 1973; 109: 553–554.
 
23. Clearfield HR, Shin YH, Schreibman BK. Emphysematous gastritis secondary to lye ingestion: Report of a case. Am J Dig Dis 1969; 14: 195–199.
 
24. Lagios MD, Suydam MJ. Emphysematous gastritis with perforation complicating phytobezoar. Am J Dis Child 1968; 116: 202–204.
 
25. Berens SV, Moskowitz H, Mellins HZ. Air within the wall of the stomach: Roentgen manifestations and a new roentgenographic sign. Am J Roentgenol Radium Ther Nucl Med 1968; 103: 310–313.
 
26. Meyers HI, Parker JJ. Emphysematous gastritis. Radiology 1967; 89: 426–431.
 
27. Sawyer RB, Wadell MC, Sawyer KC, et al. Emphysematous gastritis. Gastroenterology 1967; 53: 452–455.
 
28. Fink DW, Boyden FM. Gas in the portal veins: A report of two cases due to ingestion of corrosive substances. Radiology 1966; 87: 741–743.
 
29. Smith TJ. Emphysematous gastritis associated with adenocarcinoma of the stomach. Am J Dig Dis 1966; 11: 341–345.
 
30. Berry WB, Hall RA, Jordan GL Jr: Necrosis of the entire stomach secondary to ingestion of a corrosive acid: Report of a patient successfully treated by total gastrectomy. Am J Surg 1965; 109: 652–655.
 
31. Han SY, Collins LC, Petrany Z. Emphysematous gastritis. JAMA 1965; 192: 222–224.
 
32. Gonzalez LL, Schowengerdt C, Skinner HH Jr, et al. Emphysematous gastritis. Surg Gynecol Obstet 1963; 116: 79–87.
 
33. Farfel B, Eichhorn RD. Emphysematous gastritis. Am J Gastroenterol 1956; 25: 125–130.
 
34. Henry GW. Emphysematous gastritis. Am J Roentgenol Radium Ther Nucl Med 1952; 68: 15–18.
 
35. Welch CE, Jones CM. Emphysematous gastritis. N Engl J Med 1947; 237: 983–985.
 
36. Ween HS. Emphysematous gastritis. Am J Roentgenol Radium Ther Nucl Med 1946; 55: 588–593.
 
37. Morton JJ, Stabins SJ. Phlegmonous gastritis of Bacillus aerogenes capsulatus (B welchii)origin. Ann Surg 1928; 87: 848–854.