Emphysematous gastritis: A young diabetic's recovery

INTRODUCTION: Emphysematous gastritis (EG) is a rare and often fatal disorder involving infection of the gastric wall by gas-forming organisms. PRESENTATION OF CASE: We present the case of a 25-year-old diabetic man with severe gastroparesis, who complained of vomiting and right upper quadrant pain. The surgical consultant exam in the emergency department revealed a tender but not acute abdomen. On abdominal computed tomographic imaging, there was gas throughout the wall of the stomach but no evidence of gastric perforation. The patient was treated non-operatively with antibiotics, bowel rest, serial abdominal exams, and upper endoscopy (EGD). DISCUSSION: EG has been associated with overall mortality rates exceeding 50%. Early recognition and administration of antibiotics is essential to reduce mortality risk. Indications for laparotomy include perforation or uncontrolled sepsis. CONCLUSION: EG can occur in diabetics with gastroparesis complicated by a bezoar and hyperemesis. Gastric pneumatosis is not an absolute indication for celiotomy as antibiotics and surgical vigilance may be appropriate and curative therapy. (C) 2012 Published by Elsevier Ltd on behalf of Surgical Associates Ltd. Open access under CC BY-NC-ND license.