Abstract
Introduction
Despite similar appearances on imaging studies, emphysematous gastritis (EG) and gastric emphysema (GE) are rare clinical entities encountered in surgical practices. The purpose of this review is to clarify the presentation, natural history, and optimal treatment strategies for these two disorders.
Methods
We conducted a comprehensive literature review for reported adult cases of EG and GE in MEDLINE. Two cases from our institution were also included. Patient with demographics, diagnostic and therapeutic data, and outcomes were compared between patients with EG and GE.
Results
A total of 75 cases were included for our review. The finding of intramural air in the stomach was often associated with portal vein gas, pneumatosis intestinalis, or pneumoperitoneum in both groups. Surgical removal of the stomach was performed in 23.1 % of EG patients, but only one patient in the GE group. In the EG group, overall mortality (55 %) appeared to be driven by sepsis and its complications, whereas in the GE group, mortality (29 %) was attributable to comorbid conditions and the underlying illness.
Conclusions
Prompt surgical intervention is more commonly indicated for severe EG and is directed at removal of the septic organ, while the primary indication for surgical intervention in GE is the uncertainty of the diagnosis.
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References
Kussin SZ, Henry C, Navarro C et al (1982) Gas within the wall of the stomach: report of a case and review of the literature. Dig Dis Sci 27:949–954
Fraenkel E (1889) Üeber einen Fall von Gastritis acute emphysematosa wahrscheinlich mykotischen Ursprungs. Virchows Arch A 118:526–535
Huang CT, Liao WY (2009) Emphysematous gastritis: a deadly infectious disease. Scand J Infect Dis 41:317–319
Moosvi AR, Saravolatz LD, Wong DH et al (1990) Emphysematous gastritis: case report and review. Rev Infect Dis 12:848–855
Schorn VJ, Baquerizo A, Mason RJ (2010) Image of the month—Emphysematous gastritis. Arch Surg 145:792
Lee S, Rutledge JN (2010) Gastric emphysema. Am J Gastroenterol 1984(79):899–904
Muthukumarasamy G, Damodharan K, Chudy M, et al. Gastric emphysema and pneumoperitoneum. ANZ J Surg. 80:945–946
Majumder S, Trikudanathan G, Moezardalan K et al (2012) Vomiting-induced gastric emphysema: a rare self-limiting condition. Am J Med Sci 343:92–93
Pear BL (1998) Pneumatosis intestinalis: a review. Radiology 207:13–19
Williford ME, Foster WL Jr, Halvorsen RA et al (1982) Emphysematous gastritis secondary to disseminated stronglyloidiasis. Gastrointest Radiol 7:123–126
de Lange EE, Slutsky VS, Swanson S et al (1986) Computed tomography of emphysematous gastritis. J Comput Assist Tomogr 10:139–141
Bloodworth LL, Stevens PE, Bury RF et al (1987) Emphysematous gastritis after acute pancreatitis. Gut 28:900–902
Williamson MR, Shah HR, Harper RR et al (1989) CT of emphysematous gastritis. Comput Med Imaging Graph 13:175–177
Monteferrante M, Shimkin P (1989) CT diagnosis of emphysematous gastritis. Am J Roentgenol 153:191–192
Caruana V, Swayne LC, Salaki JS (1990) Indium-111 WBC detection of emphysematous gastritis in pancreatitis. J Nucl Med 31:112–114
Binmoeller KF, Benner KG (1992) Emphysematous gastritis secondary to gastric infarction. Am J Gastroenterol 87:526–529
McKelvie PA, Fink MA (1994) A fatal case of emphysematous gastritis and esophagitis. Pathology 26:490–492
Van Allan RJ, Krebs TL, Henzie GM et al (1995) Emphysematous gastritis in an immunocompromised host. Clin Imaging 19:129–130
Lin CY, Lee CS, Lin DY et al (1995) Emphysematous gastritis secondary to acute gastric dilatation. J Gastroenterol Hepatol 10:612–615
Sud A, Lehl SS, Bhasin DK et al (1996) Emphysematous gastritis. Am J Gastroenterol 91:604–605
Bashour CA, Popovich MJ, Irefin SA et al (1998) Emphysematous gastritis. Surgery 123:716–718
Cherney CL, Chutuape A, Fikrig MK (1999) Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: case report and literature review. Am J Gastroenterol 94:252–256
Shipman PJ, Drury P (2001) Emphysematous gastritis: case report and literature review. Australas Radiol 45:64–66
Wong YY, Chu WC (2002) Emphysematous gastritis associated with gastric infarction in a patient with adult polycystic renal disease: CT diagnosis. Am J Roentgenol 178:1291
van Mook WN, van der Geest S, Goessens ML et al (2002) Gas within the wall of the stomach due to emphysematous gastritis: case report and review. Eur J Gastroenterol Hepatol 14:1155–1160
Ho DC, Moore LA, Downey DB (2002) Residents’ corner. Answer to case of the month #86. Emphysematous gastritis. Can Assoc Radiol J. 53:309–311
Yalamanchili M, Cady W (2003) Emphysematous gastritis in a hemodialysis patient. South Med J 96:84–88
Gutierrez O, Cantalapiedra A, Tabuyo MI et al (2003) Emphysematous gastritis and severe aplastic anemia. Hematol J 4:82–84
Buyl L, Smeets P, Verstraete K (2003) Infectious emphysematous gastritis in multiple sclerosis. JBR-BTR. 86:148–149
Ocepek A, Skok P, Virag M et al (2004) Emphysematous gastritis—case report and review of the literature. Z Gastroenterol 42:735–738
Allan K, Barriga J, Afshani M et al (2005) Emphysematous gastritis. Am J Med Sci 329:205–207
Abboud B, Mchayleh W, Sleilaty G et al (2006) Gastric pneumatosis as a manifestation of ischemic infarction of the stomach. Report of a case and review of the literature. J Med Liban 54:217–220
Iqbal M, Ishtiaq O, Akhtar A et al (2006) Empysematous gastritis–a case report with literature review. J Pak Med Assoc 56:605–607
Loi TH, See JY, Diddapur RK et al (2007) Emphysematous gastritis: a case report and a review of literature. Ann Acad Med Singapore 36:72–73
Carlson AP, Chan JW, Ketai LH et al (2007) Emphysematous gastritis in a severely burned patient: case report and literature review. J Trauma 62:765–767
Lee SM, Kim GH, Kang DH et al (2007) Education and imaging. Gastrointestinal: emphysematous gastritis. J Gastroenterol Hepatol 22:2036
Jung JH, Choi HJ, Yoo J et al (2007) Emphysematous gastritis associated with invasive gastric mucormycosis: a case report. J Korean Med Sci 22:923–927
Al-Jundi W, Shebl A (2008) Emphysematous gastritis: case report and literature review. Int J Surg. 6:63–66
Agarwal N, Kumar S, Sharma MS et al (2009) Emphysematous gastritis causing gastric and esophageal necrosis in a young boy. Acta Gastroenterol Belg 72:354–356
Dawwas MF, Sivaprakasam R, Butler AJ et al (2010) Emphysematous gastritis in a liver transplant recipient. Liver Transpl 16:104–105
Arezzo A, Famiglietti F, Garabello D et al (2011) Complete resolution of emphysematous gastritis after conservative management. Clin Gastroenterol Hepatol 9:e30
Hassan S, Abbass K, Markert R et al (2011) Emphysematous gastritis associated with ulcerative esophagitis. Eur Rev Med Pharmacol Sci 15:1336–1338
Ferrada PA (2012) Successful surgical treatment of emphysematous gastritis on a patient with poor cardiac function. Am Surg 8:66–67
Philips RL, Rabin MS (1981) Gastric emphysema due to carcinoma. Australas Radiol 25:19–20
Kowal LE, Glick SN, Teplick SK (1982) Gastric emphysema resembling pneumoperitoneum: presentation of a case with a review of the literature. Am J Gastroenterol 77:667–670
Vade A, Jafri SZ, Agha FP et al (1983) Radiologic evaluation of gastrostomy complications. Am J Roentgenol 141:325–330
Agha FP (1984) Gastric emphysema: an etiologic classification. Australas Radiol 28:346–352
Martin DF, Hartley G (1986) Gastric emphysema demonstrated by computed tomography. Br J Radiol 59:505–507
Tuck JS, Boobis LH (1987) Interstitial emphysema of the stomach due to perforated appendicitis. Clin Radiol 38:315–317
Lowe GM, Bernfield JB, Smith CS et al (1990) Gastric pneumatosis: sign of biliary stent-related perforation. Radiology 174:1037–1038
Badrinath K, Jairam N, Ravi HR et al (1992) Gastric emphysema following drug-induced gastritis. Br J Surg 79:320
Hadas-Halpren I, Hiller N, Guberman D (1993) Emphysematous gastritis secondary to ingestion of large amounts of Coca Cola. Am J Gastroenterol 88:127–129
Chintapalli KN (1994) Gastric bezoar causing intramural pneumatosis. J Clin Gastroenterol 18:264–265
Low VH, Thompson RI (1995) Gastric emphysema due to necrosis from massive gastric distention. Clin Imaging 19:34–36
Omojola MF, Pirani MK, Sylven M et al (1997) Computed tomographic evaluation of gastric emphysema–a report of three cases. Clin Radiol 52:381–383
Ulloa Ramirez SA, Ortiz Justiniano VN, Soler Candelaria E et al (1997) Gastric emphysema simulating perforated hollow viscus: case report and review of literature. Bol Asoc Med P R 89:200–202
Millward SF, Fortier M (2001) Transient gastric emphysema caused by colonic infarction. Am J Roentgenol 176:1331–1332
Sproat M, Huddy J, Wafula J et al (2004) Acute gastroparesis secondary to gastric emphysema: a rare complication of balloon dilation. Gastrointest Endosc 60:667–669
Soon MS, Yen HH, Soon A et al (2005) Endoscopic ultrasonographic appearance of gastric emphysema. World J Gastroenterol 11:1719–1721
Zenooz NA, Robbin MR, Perez V (2007) Gastric pneumatosis following nasogastric tube placement: a case report with literature review. Emerg Radiol 13:205–207
Kalina M, Rubino M (2009) Recurrent gastric emphysema. Am Surg 75:1149–1151
Moon SW, Lee SW, Choi SH et al (2010) Gastric emphysema after methyl ethyl ketone peroxide ingestion. Clin Toxicol 48:90–91
Barbour JR, Stokes JP, Uflacker A et al (2010) Spontaneous gastric pneumatosis causing abdominal pain. Am Surg 76:220–222
Chou JW, Tseng YC, Tseng CK (2010) A rare complication of chemotherapy in a 56-year-old patient. Gastric emphysema. Gastroenterology 139:1–2
Reuter H, Bangard C, Gerhardt F et al (2011) Extensive hepatic portal venous gas and gastric emphysema after successful resuscitation. Resuscitation 82:238–239
Hyun YS, Han DS, Lee HL et al (2011) Gastric emphysema after endoscopic submucosal dissection. Endoscopy 43:83–84
Chang YL, Lu YY, Huang CC et al (2011) Education and imaging. Gastrointestinal: gastric emphysema and pneumoperitoneum with spontaneous resolution. J Gastroenterol Hepatol 26:786
Cherian SV, Das S, Khara L et al (2011) Gastric emphysema associated with diabetic gastroparesis. Intern Med 50:1777
Kerschaever I, Poelmans S, Vankeirsbilck J et al (2012) Rare cause of gastric outlet obstruction: incarcerated pylorus within an inguinal hernia. Ann R Coll Surg Engl 94:46–48
Ilyas C, Young AL, Lewis M et al (2012) Parastomal hernia causing gastric emphysema. Ann R Coll Surg Engl 94:72–73
St Peter SD, Abbas MA, Kelly KA (2003) The spectrum of pneumatosis intestinalis. Arch Surg 138:68–75
Duron VP, Rutigliano S, Machan JT et al (2011) Computed tomographic diagnosis of pneumatosis intestinalis: clinical measures predictive of the need for surgical intervention. Arch Surg 146:506–510
Soybel DI (2005) Anatomy and physiology of the stomach. Surg Clin North Am 85:875–894
Saha A, Hammond CE, Beeson C et al (2010) Helicobacter pylori represses proton pump expression and inhibits acid secretion in human gastric mucosa. Gut 59:874–881
Soybel DI, Modlin IM (1993) Overview of gastric mucosal injury and inflammation. In: Kozol RA (ed) Gastritis. CRC Press, Boca Raton, pp 1–34
Shindo K, Machida M, Fukumura M et al (1998) Omeprazole induces altered bile acid metabolism. Gut 42:266–271
Mowat C, Williams C, Gillen D et al (2000) Omeprazole, Helicobacter pylori status, and alterations in the intragastric milieu facilitating bacterial N-nitrosation. Gastroenterology 119:339–347
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Matsushima, K., Won, E.J., Tangel, M.R. et al. Emphysematous Gastritis and Gastric Emphysema: Similar Radiographic Findings, Distinct Clinical Entities. World J Surg 39, 1008–1017 (2015). https://doi.org/10.1007/s00268-014-2882-7
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DOI: https://doi.org/10.1007/s00268-014-2882-7