Emphysematous gastritis: a case series and review of the current trend favoring conservative management

Emphysematous gastritis [EG] is a rare condition associated with a high mortality rate which involves the invasion of gas-forming organisms into the gastric mucosa. Risk factors include mucosal defects such as gastric ulceration as well as systemic illnesses such as diabetes. Clinical presentation includes abdominal pain as well as signs of sepsis. Air in the gastric wall and portal venous system on abdominal imaging are characteristic radiographic findings. The ideal treatment of the condition is unclear, given its rarity. Cases have typically involved either surgical options or conservative management with bowel rest and intravenous antibiotics. We report on two patients treated successfully at our institution with conservative management and a review of the current knowledge in this area. Recent case literature shows a trend towards conservative management for emphysematous gastritis with several successfully managed cases, suggesting that patients can avoid surgery in the majority of cases.