Emphysematous gastritis due to gastric necrosis/infarction
Severe abdominal pain and haematemesis. Gross metabolic acidosis (pH = 7) with markedly raised serum lactate.
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The stomach is distended and filled with material that contains multiple air bubbles. Note gross thinning of the gastric wall at the fundus and gas within the residual wall of the lower gastric body (arrows). Appearances indicate sloughing of the mucosa and other layers of the wall into the lumen with associated haematoma. Note that the SMA and coeliac axis enhance normally. No other organs show ischaemic change and the small bowel is normal.
Acute gastric ischemic necrosis and emphysematous gastritis are rare because of the stomach’s rich vascular supply. Causes including thrombosis of mesenteric arteries, acute gastric dilatation, bulimia, and Prader-Willi syndrome; intrathoracic herniation with volvulus, so called acute necrotizing gastritis, ingestion of caustic substances, therapeutic embolizations, and postoperative complication following procedures around the stomach. It may also be indiopathic.