Emphysematous gastritis: A young diabetic's recovery.
BACKGROUND
Emphysematous gastritis (EG) is a rare and often fatal disorder involving infection of the gastric wall by gas-forming organisms.


METHODS
We present the case of a 25-year-old diabetic man with severe gastroparesis, who complained of vomiting and right upper quadrant pain. The surgical consultant exam in the emergency department revealed a tender but not acute abdomen. On abdominal computed tomographic imaging, there was gas throughout the wall of the stomach but no evidence of gastric perforation. The patient was treated non-operatively with antibiotics, bowel rest, serial abdominal exams, and upper endoscopy (EGD).


CONCLUSIONS
EG has been associated with overall mortality rates exceeding 50%. Early recognition and administration of antibiotics is essential to reduce mortality risk. Indications for laparotomy include perforation or uncontrolled sepsis.


CONCLUSIONS
EG can occur in diabetics with gastroparesis complicated by a bezoar and hyperemesis. Gastric pneumatosis is not an absolute indication for celiotomy as antibiotics and surgical vigilance may be appropriate and curative therapy.
Division of Thoracic/Foregut Surgery, Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
James
J
Iannuzzi
Thomas J
TJ
Watson
Virginia R
VR
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