# Clostridium associated emphysematous gastritis: A case report and review of literature

## TL;DR

A rare case of Clostridium-associated emphysematous gastritis in a 77-year-old woman is reported, highlighting the importance of early diagnosis and aggressive treatment for survival.

## Contribution

This case report documents a rare instance of Clostridium perfringens causing emphysematous gastritis without trauma or malignancy, emphasizing successful surgical intervention.

## Key findings

- Clostridium perfringens was identified as the causative agent in a case of emphysematous gastritis.
- Aggressive surgical treatment led to survival in a high-risk patient with this rare condition.
- Literature review shows few human cases of Clostridium-associated emphysematous gastritis with definitive identification.

## Abstract

Emphysematous gastritis is a rare, often fatal infection of the stomach wall characterized by gas formation and tissue necrosis, most frequently associated with polymicrobial infections. Cases with demonstration of tissue invasion by Clostridium species are exceptionally uncommon. We report the case of a 77-year-old woman with multiple comorbidities, including diabetes mellitus, obesity, atherosclerosis, and chronic kidney disease, who presented with severe abdominal pain, nausea, and vomiting. Imaging revealed gastric emphysema with pneumoperitoneum. Emergent laparotomy demonstrated full-thickness necrosis of the stomach along the lesser curvature, necessitating total gastrectomy with Roux-en-Y esophagojejunostomy and splenectomy. Histopathology confirmed extensive necrosis with gas dissection and abundant gram-positive, boxcar-shaped bacilli consistent with Clostridium perfringens. This case highlights the pathogenic potential of C. perfringens to cause spontaneous, necrotizing emphysematous gastritis in the absence of trauma or malignancy. Vascular compromise from severe atherosclerosis and thrombosis likely contributed to tissue hypoxia, creating a permissive environment for clostridial invasion. A literature review identified only a handful of human cases of emphysematous gastritis with definitive Clostridium identification, most with fatal outcomes unless surgically managed.

Emphysematous gastritis associated with Clostridium species is exceedingly rare and rapidly progressive. Early recognition and aggressive surgical resection appear to offer the best chance of survival. Clinicians should maintain a high index of suspicion in high-risk patients presenting with acute abdominal symptoms and gastric wall emphysema.

•Exceptionally rare emphysematous gastritis with Clostridium associated invasion.•Survival achieved after emergent total gastrectomy with Roux-en-Y reconstruction.•Highlights importance of early diagnosis and treatment in high-risk cases.

Exceptionally rare emphysematous gastritis with Clostridium associated invasion.

Survival achieved after emergent total gastrectomy with Roux-en-Y reconstruction.

Highlights importance of early diagnosis and treatment in high-risk cases.