Journal Article

Emphysematous Gastritis and Gastric Emphysema: Similar Radiographic Findings, Distinct Clinical Entities

Won, Eugene J., Tangel, Matthew R., Matsushima, Kazuhide, Enomoto, Laura M., Soybel, David I., Avella, Diego M.

2015

Overview

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.

• Publisher: Springer US,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Anti-Bacterial Agents - therapeutic use / Bacterial Infections - complications / Cardiac Surgery / Diagnosis, Differential / Emphysema - diagnostic imaging / Emphysema - microbiology / Emphysema - therapy / Endoscopy, Digestive System / Gastrectomy / Gastric Distension / Gastric Outlet Obstruction / Gastric Wall / Gastritis - diagnostic imaging / Gastritis - microbiology / Gastritis - therapy / General Surgery / Humans / Medicine / Medicine & Public Health / Portal Vein - diagnostic imaging / Radiography / Scientific Review / Sepsis - microbiology / Stomach Diseases - diagnostic imaging / Stomach Diseases - microbiology / Stomach Diseases - therapy / Stomach Wall / Surgery / Thoracic Surgery / Total Gastrectomy / Vascular Surgery