Emphysematous Gastritis: Is Surgical Management Mandatory? A Case Report

Abstract

Introduction: The radiological finding of gas dissecting the gastric wall is rare and is associated with two conditions: emphysematous gastritis, which involves infection by gas-producing bacteria and has a severe course with a mortality rate exceeding 50%, and gastric emphysema, which is predominantly caused by mechanical factors and has a more benign prognosis. In cases of gastric pneumatosis, early diagnosis and timely treatment are crucial to preventing complications.

Case Presentation: A 62-year-old male patient presented to the emergency department with abdominal pain, distension, and diarrhea. He was hemodynamically stable and showed no signs of peritoneal irritation. Computed tomography revealed gastric pneumatosis associated with pneumoperitoneum. The patient was managed conservatively with antibiotics and demonstrated a successful recovery, with complete resolution of symptoms and radiological findings.

Discussion: Various etiologies can cause gastric pneumatosis; however, when associated with pneumoperitoneum, the diagnostic suspicion leans toward emphysematous gastritis, a condition that typically follows a severe course and often necessitates surgical management. Nonetheless, cases managed conservatively with positive outcomes have been reported.

Conclusion: Early recognition of patients with emphysematous gastritis is critical to reducing complications such as gastric perforation or death. Historically, these patients warranted surgical intervention; however, recent case reports suggest that conservative management can be effective. There is no consensus on the standard approach for patients presenting with gastric pneumatosis.