Gastric emphysema

Case contributed by Dr Jeffrey Cheng

Presentation

Presented with right sided abdominal pain radiating to the right flank. Intermittently present for the last 3-4 months. Subjective fevers and productive cough.

Patient Data

Age: 55
Gender: Male
CT

There are multiple locules of gas in the periphery of the liver which appear
to be within the portal venous system. A locule of gas is located in a left gastric vein, with apparent gas within the mucosae of the stomach. Hepatic steatosis with some distension of the oesophagus.

No free intra-abdominal gas or fluid. The spleen, kidneys, adrenals and pancreas are unremarkable. There is no hydronephrosis,hydroureter or renal calculi. No perinephric fat stranding. No intra-abdominal fat stranding. Normal appearance of the bowel. Patchy ground glass change with some tree-in-bud opacities through the lower zones of the lungs. 

Summary:
Portal venous gas appears to arise from gastric emphysema. Given clinical status of patient, emphysematous gastritis will have to be ruled out. Lower zone opacities possibly representing bronchopneumonia.

Case Discussion

Gastric emphysema is a relatively rare finding and could represent potentially serious pathology. 

Differentials include:

  • raised intragastric pressure (eg. gastric outlet obstruction)
  • post-gastroscopy (from air insufflation from instrumentation)
  • severe mucosal injury (eg. from violent vomiting)
  • dissection of air from the mediastinum (eg. pneumothorax)

Emphysematous gastritis is the other cause of this radiographic appearance and represents proliferation of gas-forming microorganisms in the gastric wall. This condition has a poor prognosis and primary treatment is with broad-spectrum intravenous antibiotics, intravenous fluids and nutritional support.

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Case information

rID: 56771
Case created: 21st Nov 2017
Last edited: 22nd Nov 2017
Inclusion in quiz mode: Included
Institution: Mater Hospital

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