S6459 A Rare Case of Emphysematous Gastritis Precipitated by Advanced Gastric Adenocarcinoma

Introduction: Emphysematous gastritis is an uncommon condition characterized by the presence of air within the stomach wall, typically attributed to gas-forming microorganisms. This condition carries a high mortality rate, emphasizing the critical importance of prompt diagnosis and treatment to prevent fatal outcomes. Here, we present a remarkably rare case of emphysematous gastritis secondary to advanced gastric adenocarcinoma. Case Description/Methods: A 60-year-old man presented to the emergency department with 1 week of right upper quadrant pain. He reported several months of severe postprandial cramping pain, exacerbated by fatty or spicy meals, and a 10-15 lb weight loss about 1 month prior to admission. Initial labs indicated elevated alkaline phosphatase levels, microcytic anemia, and new onset transaminitis, with an R factor of 0.6, suggesting cholestatic injury. Right upper quadrant ultrasound revealed nonspecific gallbladder wall thickening, mild common bile duct dilation and no cholelithiasis. Subsequent magnetic resonance cholangiopancreatography revealed nonspecific gallbladder wall thickening, but no visible intraductal mass or calculi. Soon after, the patient became unresponsive and hemodynamically unstable. The patient was intubated, started on vasopressor support, and transferred to the intensive care unit. Following stabilization, a STAT computed tomography (CT) abdomen and pelvis with intravenous contrast was preformed which revealed emphysematous gastritis with a sizable 7.4 × 14.0 cm gas-containing, rim-enhancing perigastric fluid collection. Prompting emergent exploratory laparotomy. Purulent fluid was found in left mid and upper abdomen, accompanied by diffuse inflammation and thickening of the stomach wall as well as a large area of gastric ischemia and necrosis, necessitating a subtotal gastrectomy. Biopsy results demonstrated poorly differentiated gastric carcinoma with signet-ring cells. Discussion: This case presentation is significant as an extensive literature review reveals only 4 previously documented cases of emphysematous gastritis linked to cancer, with just 2 associated with gastric adenocarcinoma. Emphysematous gastritis’s rarity and subsequent lethality requires a high level of clinical suspicion for timely diagnosis and intervention. This case highlights the rapid progression of the disease and the consequences of misdiagnosis. Early detection can enable successful medical management, avoiding the necessity for surgery. However, the condition's rarity often complicates diagnosis.