A Case of Gastric Emphysema with Intra-abdominal Free Gas and Mediastinal Emphysema that Resolved with Conservative Treatment

Abstract

The patient was a 64-year-old woman. For these several years she was on post-tracheostomy and gastrostomy nutrition due to multiple system atrophy. Two days before coming to our hospital, enteral tube feeding fluid flew out through her tracheostomy orifice after nutritional administration. She had fever and was admitted to our hospital with a suspected diagnosis of pneumonia. A CT scan showed intragastric emphysema and intra-abdominal free gas and mediastinal emphysema. She was conservatively treated because abdominal symptoms and findings suggestive of ischemia were absent. Seven days later, a CT scan showed that the findings had disappeared, and 9 days later, upper gastrointestinal endoscopy confirmed that there were no ischemic changes in the mucosa. Her nutrient administration was resumed. Seven days after the resumption, flowing out of the nutrient from the tracheostomy orifice flared up again, and a CT scan showed intramural emphysema and portal venous gas, but the patient again recovered with conservative treatment. Most cases of gastric emphysema have a good prognosis with conservative treatment. Intra-abdominal free gas, portal gas, and mediastinal emphysema are findings suggestive of gastrointestinal perforation or intestinal ischemia, but surgery may be avoided if no abdominal symptoms are present. It is important to make a judgment based not only on imaging findings but also on the patient's general condition and physical examination.