An 80-year-old female patient was admitted in respiratory distress following a house-fire. She was intubated on admission. A diagnosis of anoxic brain injury secondary to smoke inhalation in addition to carbon monoxide poisoning was made.
A wide bore suction NG was placed in ICU shortly after admission to decompress the stomach. Her condition stabilised, she was extubated and was discharged from ICU to a non-acute ward on day 3. Oral feeding was deemed unsafe on formal swallow assessment and on day 10, her wide bore suction NG was exchanged for a feeding NG tube. She subsequently received her daily nutrition via this tube. The NG tube required multiple reinsertions due to accidental dislodgement (as a result of the patient’s confused state). She underwent multidisciplinary rehabilitation over the following weeks.
On day 34, the patient became unsettled and appeared to be in some pain. As a result of the anoxic brain injury, she was unable to verbalise making clinical assessment difficult. On examination, she recoiled to deep palpation throughout the abdomen. Her vital signs and routine blood tests were stable when compared with baseline measurements.
surgical consultation, the patient was managed conservatively and her condition
settled clinically over the following days.
I wish to acknowledge the contribution of Dr Suzanne Shine, Consultant Radiologist, and Dr Jan Gerstenmaier, Radiology Registrar, St. Vincent's University Hospital, Dublin, Ireland.
intramural air is a rare entity. It should be considered in the presence of an
unusual gas pattern in the left upper quadrant on abdominal radiograph. In many
cases, the stomach circumference is outlined with linear lucencies. In others,
such as our case, the intramural air is more localized and a mottled gas
pattern is seen in the left upper quadrant. A CT scan will confirm the presence
of air in the stomach wall, demonstrate the extent, show portal venous air if
present and may also give valuable information regarding the underlying cause.
emphysema has many aetiologies which can be broadly divided into gastric and
extragastric causes. Emphysematous
gastritis is clinically distinct from the other causes as the patient is
seriously ill and has a poor prognosis. On the contrary, other causes of
gastric emphysema usually respond well to conservative management and the condition
tends to resolve spontaneously, as was the case with our patient. Zenooz et al1 report a case of gastric emphysema secondary to intramural nasogasrtic tube placement.
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