A Case of Intragastric Emphysema and Portal Vein Emphysema During Nasogastric Tube Placement

Abstract

We report a case of intragastric emphysema caused by placement of a nasogastric tube that developed into portal venous gas. A 72-year-old man was transferred for rehabilitation following treatment for a left cerebral infarction. The patient was being fed through a nasogastric tube. On the 6th day after transfer, he developed hematochezia and hypotension. Abdominal CT revealed gastric wall emphysema and extensive portal venous gas. Since there were no signs of intestinal perforation, necrosis, or ischemia, we diagnosed the patient as having intragastric emphysema and treated the patient conservatively. After six days, a repeat CT showed resolution of both the intragastric emphysema and portal venous gas. Gastrointestinal endoscopy revealed no active ulcers or mucosal defects. Gastric intramural emphysema can be caused by a variety of factors, including placement of nasogastric tubes, prolonged bed rest, and tracheal intubation, and its symptoms are diverse, including abdominal pain, vomiting, and hematochezia. While intragastric emphysema can be relieved with conservative treatment, surgery may be required for emphysematous gastritis, and careful follow-up and preparation for surgery are important.