Emphysematous Gastritis in a Patient with Dementia

Abstract

A 91-year-old woman with dementia was transported by ambulance with a history of vomiting and abdominal pain. Her vital signs were stable. Abdominal examination and blood tests showed few findings suggestive of severe intraperitoneal infection. Abdominal CT showed pronounced gas shadows in the portal vein and foamy intramural emphysema in the stomach, descending duodenum and proximal jejunum. Although the CT images showed findings characteristic of emphysematous gastritis, we suspected gastric emphysema based on the patient’s clinical presentation, including excessive vomiting. CT performed on the following day revealed remarkable improvement of the vascular gas shadows and intramural emphysema, and showed wall thickening of the same portion of the gastrointestinal tract. Culture of bloody gastric juice specimens obtained at the time of admission was positive for three kinds of gas-producing bacteria. Based on information from the family of the patient, our isolation of gas-producing bacteria and the findings of upper gastrointestinal endoscopy performed on day 7 of hospitalization, we concluded that our patient had emphysematous gastritis caused by her poor personal hygiene due to dementia. Her condition resolved successfully with conservative management.