〔Case 1〕A 71-year-old woman was admitted to our hospital because of acute heart failure. She had a history of diabetes, rheumatoid arthritis and atrial fibrillation. She was bedridden after suffering from cardiogenic cerebral embolism while being hospitalized. On day 127 after admission, she developed high fever and hypotension of sudden onset. Investigations revealed leukocytosis. She was suspected as having septic shock, and while seeking the septic focus, we performed computed tomography (CT) . CT showed air in the wall of the stomach and wall thickening with portal venous gas. Based on these findings, emphysematous gastritis was diagnosed. Broad-spectrum antibiotics were administered immediately after obtaining a blood sample for bacterial culture. On day 140 after admission, endoscopic examination was performed, which revealed a giant ulcer with a yellow-white membrane in the posterior wall of the stomach.
〔Case 2〕A 65-year-old woman was admitted to our hospital with myalgia. She had a history of amyotrophic lateral sclerosis (ALS) and diabetes mellitus. She was using a ventilation device and had a percutaneous gastrostomy feeding tube. She was diagnosed as having polymyalgia rheumatica and started on treatment with low-dose prednisolone. On day 25 after admission, she developed epigastric pain and nausea of sudden onset, and a bloody drainage from the gastrostomy tube. We suspected gastrointestinal hemorrhage and performed emergency endoscopy. Endoscopic examination revealed a giant ulcer and erosions in the posterior wall of the stomach. Abdominal CT showed gas within a thickened gastric wall and also in the peripheral portal venous radicals. Based on the imaging findings, the patient was diagnosed as having emphysematous gastritis. The patient was commenced on broad-spectrum antibiotics. Klebsiella pneumoniae was cultured from the gastric mucosa.
〔Conclusion〕We encountered two rare cases of emphysematous gastritis with portal venous gas.
