Gastric emphysema

Case contributed by Dr Jayanth Keshavamurthy

Presentation

KUB radiograph was obtained for abdominal pain, followed by an additional CT scan of the abdomen.

Patient Data

Age: 80 years
Gender: Male

What is the finding?

X-ray

Mottled gas overlying stomach.

CT

Intramural gas in the posterior wall of stomach in a non dependent fashion.

 

Important pertinent negatives that need mentioning are-

1. If there is free peritoneal air.

2. Pneumatosis intestinalis.

3. Check if there is any recent instrumentation like NG tube and or upper endoscopy.

4. Also recommend gastroenterology and or surgery consult to watch for any worsening as it is not possible to exclude emphysematous gastritis from gastric emphysema which has has a more benign course and outcome.

EGD Findings 
Esophagus: 
Esophageal mucosa was normal, with Z-line at 45 cm. 
Stomach: 
Large amount of bile was seen in stomach. Gastric mucosa was diffusely erythematous without evidence of perforation. Some mosaic pattern was seen suggestive of portal hypertensive gastropathy. No biopsies were obtained.  
Duodenum: 
Normal duodenal mucosa 

Case Discussion

So far the patient has been managed conservatively. Patient is doing well even few weeks later.

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