Emphysematous Gastritis With Portal and Mesenteric Venous Gas Complicated by Septic Shock and Ileus: A Case Report

TL;DR

A rare case of emphysematous gastritis with severe complications was successfully treated without surgery, emphasizing the importance of prompt diagnosis and intensive care.

Contribution

This case report presents a rare clinical scenario of emphysematous gastritis complicated by septic shock and non-operative recovery.

Findings

Emphysematous gastritis with portal and mesenteric venous gas was diagnosed in a patient with septic shock.

Non-operative management with intensive care led to clinical stabilization and eventual discharge.

The case underscores the potential for recovery without surgery when carefully monitored.

Abstract

Emphysematous gastritis (EG) is an uncommon, life-threatening cause of intramural gastric gas that may be accompanied by portal venous gas and shock.

An older adult with diabetes, vascular comorbidities, and chronic constipation presented with three days of worsening generalized abdominal pain following a home-administered enema and arrived profoundly hypotensive with metabolic acidosis and elevated lactate. Non-contrast computed tomography (CT) (limited by renal dysfunction) demonstrated gas in the posterior gastric wall consistent with emphysematous gastritis, with hepatic portal venous gas (HPVG) and mesenteric venous gas, and associated ileus without pneumoperitoneum.

The patient was managed conservatively in intensive care with hemodynamic support, bowel rest, nasogastric decompression, intravenous (IV) proton pump inhibitor therapy, broad-spectrum antimicrobials (with subsequent de-escalation), and parenteral nutrition, with clinical stabilization and discharge. Follow-up imaging and/or endoscopy was not completed as an inpatient due to family preference.

This case highlights the need for rapid imaging and multidisciplinary risk stratification when emphysematous gastritis is suspected in shock and illustrates the potential for recovery with carefully monitored non-operative management.

Figures