Advertisement

Emergency Radiology

, Volume 18, Issue 1, pp 65–73 | Cite as

Gastric pneumatosis: the role of CT in diagnosis and patient management

  • Pamela T. JohnsonEmail author
  • Karen M. Horton
  • Barish H. Edil
  • Elliot K. Fishman
  • William W. Scott
Pictorial Essay

Abstract

Gastric pneumatosis is rare, with causes ranging from benign to lethal. The purpose of this pictorial essay is to present a series of cases of gastric pneumatosis, review the causes, and demonstrate how computed tomography (CT) can help guide management. A range of primary gastric pathology can cause air in the wall of the stomach. However, gastric pneumatosis may reflect intraabdominal pathology arising from other hollow viscera, with indicators of the extragastric etiology on CT.

Keywords

Stomach Pneumatosis Gastric emphysema Emphysematous gastritis Bowel ischemia Computed tomography 

References

  1. 1.
    Hawn MT, Canon CL, Lockhart ME et al (2004) Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract. Am Surg 70:19–23, discussion 23–24PubMedGoogle Scholar
  2. 2.
    Moosvi AR, Saravolatz LD, Wong DH, Simms SM (1990) Emphysematous gastritis: case report and review. Rev Infect Dis 12:848–855PubMedGoogle Scholar
  3. 3.
    Seaman W, Fleming RJ (1967) Intramural gastric emphysema. AJR 101:431–436Google Scholar
  4. 4.
    Kussin SZ, Henry C, Navarro C, Stenson W, Clain DJ (1982) Gas within the wall of the stomach: report of a case and review of the literature. Dig Dis Sci 27:949–954CrossRefPubMedGoogle Scholar
  5. 5.
    Lunca S, Rikkers A, Stanescu A (2005) Acute massive gastric dilatation: severe ischemia and gastric necrosis without perforation. Rom J Gastroenterol 14:279–283PubMedGoogle Scholar
  6. 6.
    Powell JL, Payne J, Meyer CL, Moncla PR (2003) Gastric necrosis associated with acute gastric dilatation and small bowel obstruction. Gynecol Oncol 90:200–203CrossRefPubMedGoogle Scholar
  7. 7.
    Kanne JP, Gunn M, Blackmore CC (2005) Delayed gastric perforation resulting from hydrochloric acid ingestion. AJR 185:682–683PubMedGoogle Scholar
  8. 8.
    Lewin M, Pocard M, Caplin S, Blain A, Tublana J-M, Parc R (2002) Benign hepatic venous gas following caustic ingestion. Eur Radiol 12:559–561Google Scholar
  9. 9.
    Zenooz NA, Robbin MR, Perez V (2007) Gastric pneumatosis following nasogastric tube placement: a case report with literature review. Emerg Radiol 13:205–207CrossRefPubMedGoogle Scholar
  10. 10.
    Lowe GM, Bernfield JB, Smith CS, Matalon TA (1990) Gastric pneumatosis: sign of biliary stent-related perforation. Radiology 174:1037–1038PubMedGoogle Scholar
  11. 11.
    Chung YF, Koo WH (2005) Gastric pneumatosis after endoscopic argon plasma coagulation. Ann Acad Med Singapore 34:569–570PubMedGoogle Scholar
  12. 12.
    Kingsley DD, Albrecht RM, Vogt DM (2000) Gastric pneumatosis and hepatoportal venous gas in blunt trauma: clinical significance in a case report. J Trauma 49:951–953CrossRefPubMedGoogle Scholar
  13. 13.
    Chintapalli KN (1994) Gastric bezoar causing intramural pneumatosis. J Clin Gastroenterol 18:264–265CrossRefPubMedGoogle Scholar
  14. 14.
    Tuck JS, Boobis LH (1987) Interstitial emphysema of the stomach due to perforated appendicitis. Clin Radiol 38:315–317CrossRefPubMedGoogle Scholar
  15. 15.
    Holt RW, Dekker J (1986) Gastric pneumatosis intestinalis associated with cholangiocarcinoma. S Med J 79:79–80Google Scholar
  16. 16.
    Zander T, Briner V, Buck F, Winterhalder R (2007) Gastric pneumatosis following polychemotherapy. Eur J Intern Med 18:251–252CrossRefPubMedGoogle Scholar
  17. 17.
    Sakamoto Y, Mashiko K, Matsumoto H, Hara Y, Kutsukata N, Yamamoto Y (2006) Gastric pneumatosis and portal venous gas in superior mesenteric artery syndrome. Indian J Gastroenterol 25:265–266PubMedGoogle Scholar
  18. 18.
    Lim JE, Duke GL, Eachempati SR (2003) Superior mesenteric artery syndrome presenting with acute massive gastric dilatation, gastric wall pneumatosis and portal venous gas. Surgery 134:840–843CrossRefPubMedGoogle Scholar
  19. 19.
    Tapia J, Murguia R, Garcia G, de los Monteros PE, Oñate E (1999) Jejunostomy: techniques, indications, and complications. World J Surg 23:596–602CrossRefPubMedGoogle Scholar
  20. 20.
    Vade A, Jafri SZ, Agha FP, Vidyasagar MS, Coran AG (1983) Radiologic evaluation of gastrostomy complications. AJR 141:325–330PubMedGoogle Scholar
  21. 21.
    Romano S, Lassandro F, Scaglione M, Romano L, Rotondo A, Grassi R (2006) Ischemia and infarction of the small bowel and colon: spectrum of imaging findings. Abdom Imaging 31:277–292CrossRefPubMedGoogle Scholar
  22. 22.
    Sebastià C, Quiroga S, Espin E, Boyé R, Alvarez-Castells A, Armengol M (2000) Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 20:1213–1224, discussion 1224-6PubMedGoogle Scholar
  23. 23.
    Cordum NR, Dixon A, Campbell DR (1997) Gastroduodenal pneumatosis: endoscopic and histological findings. Am J Gastroenterol 92:692–695PubMedGoogle Scholar
  24. 24.
    Mclaughlin SA, Nguyen JH (2007) Conservative management of nongangrenous esophageal and gastric pneumatosis. Am Surg 73:862–864PubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2010

Authors and Affiliations

  • Pamela T. Johnson
    • 1
    Email author
  • Karen M. Horton
    • 2
  • Barish H. Edil
    • 3
  • Elliot K. Fishman
    • 2
  • William W. Scott
    • 2
  1. 1.The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins HospitalBaltimoreUSA
  2. 2.The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA

Personalised recommendations