A Case of Emphysematous Gastritis in a Patient Undergoing Tube Feeding

Abstract

A 77–year–old female patient with a past medical history of diabetes mellitus and autoimmune hepatitis receiving treatment with prednisolone was hospitalized for subarachnoid hemorrhage, and underwent coil embolization. The patient was started on tube feeding, and 6 days later, she developed fever, vomiting and epigastric pain. Physical examination revealed intense epigastric tenderness. CT imaging showed air within the gastric wall, edematous mucosa of the pylorus, and a small amount of portal venous gas. Urgent esophagogastroduodenoscopy showed markedly inflamed and partially necrotic mucosa from the gastric body to the pylorus. Exploratory laparotomy was performed because transmural ischemia of the stomach was suspected. However, the gastric serosa was intact, and the gastrostomy tube was inserted from the anterior wall of the pylorus into the duodenum. Culture of a specimen of gastric mucosa was positive for Klebsiella pneumoniae. Antibiotic therapy was de–escalated from meropenem/vancomycin to cefotaxime. Repeat endoscopy revealed recovery of the gastric mucosa 9 days after the surgery and enteral feeding was started. The patient was discharged 3 months after the surgery. Emphysematous gastritis is a rare, but life–threatening disease, and herein, we discuss the pathophysiology and treatment of the disease.