S5071 Conservative Management of Emphysematous Gastritis in Diverse Clinical Contexts: A Case Series

Introduction: Emphysematous gastritis is a rare, life-threatening form of gastritis marked by gas within the gastric wall due to invasion by gas-forming organisms. While typically seen in patients with comorbidities such as diabetes mellitus, immunosuppression, or alcohol use disorder, it can also occur in younger patients with more subtle risk factors. The condition presents with nonspecific gastrointestinal symptoms like abdominal pain, nausea, and vomiting, often delaying diagnosis. Early recognition is critical, as it can progress to gastric necrosis, sepsis, and death if untreated. Computed tomography remains the gold standard for diagnosis, helping differentiate it from gastric emphysema—a benign, noninfectious condition with a favorable prognosis and mostly conservative treatment. Case Description/Methods: We present 2 distinct cases of emphysematous gastritis successfully managed without surgical intervention. The first involves a 24-year-old previously healthy man with a significant history of chronic alcohol use, presenting with acute epigastric pain and non-bilious vomiting. Computed tomography (CT) showed intramural gastric gas without signs of perforation He was managed conservatively with bowel rest, intravenous fluids (IV), nasogastric decompression, IV pantoprazole, and empiric antibiotics (piperacillin/tazobactam). Surgical intervention was not required, he improved within 72 hours and was discharged on oral antibiotics. The second case involves a 78-year-old man with alcoholic cirrhosis and recent NSAID use, presenting with epigastric pain, vomiting, and diarrhea. CT revealed gas in the gastric wall and portal venous system. Despite his comorbidities and concurrent acute kidney injury, he remained stable. He was treated with IV fluids, bowel rest, and pantoprazole. Endoscopy showed diffuse inflammation without necrosis or perforation, and he was discharged on oral pantoprazole with instructions to avoid NSAIDs. Discussion: These cases illustrate that emphysematous gastritis may present across a broad clinical spectrum—from young adults with isolated behavioral risk factors to elderly patients with cirrhosis and NSAID exposure. Conservative management with close monitoring can lead to excellent outcomes in the absence of systemic toxicity or surgical indications. Timely diagnosis, guided by clinical suspicion and confirmatory imaging, along with individualized treatment plans, are essential for optimal patient care in this rare but potentially fatal condition.