Gastric Emphysema and Emphysematous Gastritis

Gastric Emphysema

• Air in the stomach wall with an appearance similar to emphysematous gastritis with a much more benign clinical course
• Caused by disruption in mucosa leading to air dissecting into wall from:
  • Gastric outlet obstruction with increased intraluminal pressure
  • Severe vomiting
  • Instrumentation-like endoscopy
  • Dissection of air from mediastinum from ruptured bleb or pneumothorax
  • Pneumatosis cystoides - submucosal air collections

  

  Air in stomach wall outlines greater curvature of stomach

Air outlines the wall of the stomach on an axial scan of the upper abdomen.

Emphysematous gastritis
 

• Rare and severe gastritis secondary to mucosal disruption and gas-forming bacterial invasion
• Characterized by air in the wall of the stomach
  
  
• Causes:
  
  
  • Ingestion of toxic material such as corrosives
  • Alcohol ingestion
  • Trauma
  • Gastric infarction
  • Ulcer disease
• Submucosa is invaded by gas-forming organisms which include:
  • Hemolytic strep
  • Clostridia Welchi
  • E. Coli
  • Staph aureus
    
    
• Clinical:
  
  
  • Sudden and violent onset of  bloody emesis
  • Fever
  • Nausea
  • Chills
  • Leukocytosis
    
    
• Imaging
  
  
  • Linear small gas bubbles in gastric wall
    • Gastric emphysema is more linear, streak-like
  • Gas in portal vein
    
    
• Prognosis:
  
  
  • 60-80% fatal
• Best way to differentiate emphysematous gastritis from gastric emphysema:
  • Look at patient
    • Patients with gastric emphysema are a asymptomatic from the bowel gas air
    • Patients with emphysematous gastritis are usually deathly ill