Emphysematous Gastritis with Delayed Gastric Perforation

Emphysematous gastritis (EG) is a rare infection of the stomach caused by gas-producing organisms. It is often associated with high mortality, and operative intervention is avoided unless medical management fails to control sepsis, or patients develop gastric perforation. We present the case of a 24-year-old female with poorly controlled diabetes who presented with persistent vomiting and severe hyperglycemia. Prompt diagnosis of EG was obtained when computed tomography of the abdomen revealed gas throughout her stomach wall and portal venous system. She was treated with antibiotics, bowel rest, and close observation. The patient returned with contained gastric perforation and was successfully managed without surgery. This case demonstrates that delayed gastric perforation as a complication of EG can be successfully managed without surgery, and in selected cases, gastric perforation is not an absolute indication for surgery.