www.mjms.usm.my © Penerbit Universiti Sains Malaysia, 2013 For permission, please email:mjms.usm@gmail.com Case Report Submitted: 12 Jul 2012 Accepted: 7 Nov 2012 Spontaneous Resolution of Emphysematous Gastritis with Vaso-occlusive Disease–A Case Report Rajesh Nair 1 , Saurabh agrawal 1 , Bhavna Nayal 2 1 Department of General Surgery, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal 576104, India 2 Department of Pathology, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal 576104, India Abstract Emphysematous gastritis secondary to vaso-occlusive disease is a surgical emergency. It is a rare yet severe form of widespread phlegmonous gastritis. It is caused by corrosive ingestion, alcohol abuse, and on rare occasions, infections. The clinical presentation is diagnostic with supportive information from contrast-enhanced computed tomography (CECT) of the abdomen and gastroduodenoscopy. Here, we describe a case of emphysematous gastritis with spontaneous vaso- occlusive disease that was successfully managed without surgery. Keywords: gastritis coeliac plexus, hepatic insuffciency, splenic infarction Introduction Emphysematous gastritis, previously known as gastritis acuta emphysematosa, is often confused with ‘gastric emphysema’ (1). Emphysematous gastritis describes air within the stomach wall with mucosal breach (1,2) and associated infection (3). Unlike patients with gastric emphysema, patients with this condition present with acute abdominal pain and prognosis is usually poor. Causative organisms include Escherichia coli, hemolytic streptococci, Clostridia welchi, and Pseudomonas aeruginosa (4). Case report A 72-year-old man, with no pre-morbid illness, presented with a history of fever, abdominal pain, and hematemesis for 15 days. General physical examination was unremarkable with no signs of decompensated liver disease. However, he had profound epigastric and left hypochondrial tenderness. He was anemic (Hb 9.2 gm%) with elevated liver enzymes (> 1000 IU) and a total count of 33.2 with bands. Hepatic viral studies were unremarkable with normal albumin and globulin levels. Gastroduodenoscopy revealed an ulcer with a nodule in the greater curvature of the stomach, without evidence of an active bleed or infarction. Contrast-enhanced computed tomography (CECT) of the abdomen showed mottled air patches in the wall of the stomach consistent with emphysematous gastritis (Figure 1). Computed tomography revealed splenic vein thrombosis (Figure 2), coeliac artery thrombosis (Figure 3), and hepatic infarction (Figure 4). Primary prothrombotic workup ruled out hypercoagulable states. He was treated conservatively with intravenous antibiotics per the culture sensitivity report. Blood transfusion was given to correct anemia. Patient showed remarkable improvement and was symptom-free in the subsequent days. Discussion Emphysematous gastritis secondary to vaso-occlusive diseases is a surgical emergency with a mortality rate of 60 to 80% (5). Prompt treatment with broad-spectrum antibiotics and surgical revascularization has been reported to be ‘lifesaving’ in several cases (5). Perforation is the commonest indication for surgical intervention, though it is often fatal. In contrast, the patient described here showed complete resolution due to early presentation, expedited diagnosis using CECT (6), and timely intervention with appropriate antibiotics. We do believe that the non-specifc ulcer was secondary to the vaso- occlusive event and the fnal histopathology was reported as non-specifc haemorrhagic gastritis. 68 Malays J Med Sci. May-Jul 2013; 20(3): 68-70