A Case of Gastric Emphysema Accompanied by Intra-abdominal Free Air Developed during Corticosteroid Treatment

Abstract

The patient was an 86-year-old man who had been treated for pneumonia in the Department of Internal Medicine in our hospital. The condition of the illness was intractable, and cryptogenic organizing pneumonia was suspected. Corticosteroid treatment was started on the 22nd hospital day, then symptomatic remission was gained. However, intra-abdominal free air was observed by an X-ray examination on the 31st hospital day. An abdominal CT scan conducted on the same day revealed intra-mural gas in the wall of the stomach as well as intra-abdominal free air. Considering a possibility of an emergency surgery, the patient was consulted to our department. As he manifested neither abdominal symptoms nor aggravation of general condition, conservative treatment was initiated. An abdominal CT scan on day 5 after the onset showed vanishing of gastric intra-mural gas and reduction of intra-abdominal free air. A gastrointestinal endoscopy on the 6th day after the onset revealed erosive gastritis at the body of stomach, however, necrosis or ulceration of the gastric mucosa was not observed. Subsequently, the dietary restrictions were gradually loosened, and the patient left the acute care ward. Here we report a case of rare gastric emphysema that was especially uncommon for accompanying by intra-abdominal free air, and for being caused by a particular medicine.