S5164 Emphysematous Gastritis: Is Medical Management the Answer?

Introduction: Emphysematous gastritis (EG) is a rare and potentially life-threatening condition where gas-producing bacteria or fungi invade the stomach wall, causing inflammation and sometimes leading to severe illness. Unlike the less dangerous gastric emphysema, EG carries a high mortality rate of up to 60%. Although first described over a century ago, EG remains difficult to diagnose because its symptoms—abdominal pain, nausea, vomiting, and diarrhea—are common to many gastrointestinal issues. In more serious cases, it can progress to fever, bleeding, or even sepsis. Common micro-organisms involved in EG include Clostridium, E. coli, Klebsiella, and Candida. A computed tomography (CT) scan is vital for early diagnosis, showing characteristic signs like gas in the stomach wall and portal venous air. While surgery is sometimes needed, growing evidence supports treating some cases conservatively. Here, we share 2 cases where medical treatment alone led to recovery. Case Description/Methods: Case 1: A 60-year-old woman with several health issues, including poorly controlled diabetes, came to the hospital with worsening abdominal pain, diarrhea, chills, and vomiting that resembled stool. A computed tomography (CT) scan showed emphysematous gastritis and portal venous gas. She was treated with intravenous (IV) fluids, antibiotics, bowel rest, and total parenteral nutrition (TPN). Endoscopy revealed damage to her stomach lining, and cultures grew Klebsiella oxytoca. After a week of care, she improved significantly, gradually moving from clear liquids to solid food. She was discharged with oral antibiotics and recovered well from the episode. Case 2: A 51-year-old man with diabetes, obesity, and chronic obstructive pulmonary disease came to the emergency department after fainting, following a bout of nausea, vomiting, and diarrhea. A CT scan showed air in his stomach wall, portal veins, and small bowel—raising concern for emphysematous gastritis and possible ischemia. He was started on IV fluids, vasopressors, broad-spectrum antibiotics, and proton pump inhibitors (PPIs). An endoscopy confirmed severe gastritis. After several days of supportive care and a follow-up endoscopy showing improvement, he was discharged on oral antibiotics and made a full recovery. Discussion: These cases highlight the importance of early recognition and treatment of emphysematous gastritis. With the right medical approach—CT imaging, endoscopy, and tailored therapy—EG can often be managed without surgery. As more cases like these emerge, it’s clear that non-surgical care can lead to positive outcomes for patients with EG.