2020 Volume 62 Issue 11 Pages 2946-2952
A 75-year-old man was hospitalized with cervical spinal cord injury. A gastric tube was inserted due to difficulty in swallowing, and enteral nutrition was initiated. He started vomiting on hospital day 22, and blood was observed draining from the gastric tube the next day. Contrast-enhanced computed tomography (CT) showed gas within the gastric wall and in the hepatic portal vein. Upper gastrointestinal endoscopy showed mucosal redness, giant rugal folds, and gastric erosion but no mucosal necrosis. Klebsiella pneumoniae, a gas-producing bacterium, was isolated from gastric juice culture. We made a diagnosis of emphysematous gastritis, removed the gastric tube, and continued with conservative treatment using a broad-spectrum antibiotic and proton pump inhibitor with total parenteral nutrition. Repeat CT on hospital day 28 revealed that the emphysematous gastritis and hepatic portal venous gas had disappeared, and repeat upper gastrointestinal endoscopy on hospital day 34 showed that the endoscopic findings had improved. Here, we report this rare case of emphysematous gastritis caused by gastric tube insertion. Early diagnosis using CT and upper gastrointestinal endoscopy and prompt treatment appear to be crucial for managing this critical condition.
