# Severe Diabetic Gastroparesis Masquerading as Emphysematous Gastritis and Surgical Abdomen

## TL;DR

A diabetic patient with gastroparesis showed severe imaging findings resembling a surgical emergency but improved with conservative treatment.

## Contribution

Highlights how diabetic gastroparesis can mimic life-threatening conditions on imaging, avoiding unnecessary surgery.

## Key findings

- Severe gastric distention and portal venous gas resolved with conservative treatment in a stable patient.
- Conservative management with prokinetics and decompression improved clinical and radiologic outcomes.
- Emphasizes the importance of recognizing gastroparesis as a mimic of surgical abdomen in diabetics.

## Abstract

A 66-year-old man with type 2 diabetes mellitus and known gastroparesis presented to the emergency department with fatigue, confusion, and hypoglycemia. During hospitalization, he developed worsening abdominal pain and distention. CT revealed marked gastric distention, extensive portal venous gas, and mesenteric air, raising concern for emphysematous gastritis, gastric outlet obstruction, or volvulus. Despite these alarming radiographic findings, the patient remained hemodynamically stable, with no peritoneal signs. Surgical consultation was obtained; however, given his clinical stability and history of gastroparesis, conservative management was pursued. Treatment included nasogastric decompression, IV fluids, and prokinetic therapy with metoclopramide and erythromycin. Within 48 hours, the patient demonstrated significant clinical and radiologic improvement, with resolution of portal venous gas and reduction in gastric distention. He was discharged on oral prokinetics and referred to a tertiary care center for ongoing gastroparesis management. This case highlights that severe diabetic gastroparesis can produce imaging findings that mimic life-threatening surgical emergencies. In hemodynamically stable patients with known motility disorders, recognition of this potential mimic is essential to avoid unnecessary surgical intervention and to guide appropriate conservative treatment.