Thanks Dr. Taylor for an interesting case of a very rare diagnosis! An older women with decompensated cirrhosis and HCC presented with acute onset fever, altered mental status, abdominal pain and hematemesis one day after microwave ablation treatment for her HCC. CT scan revealed diffuse gastric wall edema with intramural gastric air and air in the portal venous system, consistent with a diagnosis of emphysematous gastritis. It was ultimately thought to be related to the recent procedure.
Emphysematous gastritis…heard of it, but maybe just remind me.
Rare, severe form of gastritis characterized by the presence of gas in the stomach wall. Mortality rate exceeds 50%
Caused by gas-producing organisms
Risk factors: corrosive ingestion, alcohol use, diabetes, abdominal surgery, mucosal disruption
Presentation varies, often see sepsis/shock, abdominal pain, hematemesis
Diagnosis is based on CT findings showing intramural gastric air
Treatment often includes surgery (gastrectomy) but some cases are treated conservatively with broad spectrum antibiotics and supportive care alone (as was the case for this patient)