1
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Lee LM, Owens LA, Krugner-Higby LA, Graham M, Simmons HA, Climans M, Brown K, Bennett AJ, Schaefer J, Meyer K, Goldberg TL. Sarcina sp. as a presumptive cause of fatal acute gastric dilation and gastric emphysema in rhesus macaques. J Vet Diagn Invest 2023; 35:698-703. [PMID: 37646249 PMCID: PMC10621543 DOI: 10.1177/10406387231193965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
A 4-y-old female and 3-y-old male rhesus macaque (Macaca mulatta), both housed in the same facility, died unexpectedly within 2 wk. Postmortem examination revealed severe gastric dilation in both macaques and gastric emphysema in the female macaque. Histologically, bacteria consistent with Sarcina sp. were present in both macaques within the lungs and lumen of the trachea, esophagus, and gastrointestinal (GI) tract without associated inflammation. Additionally, in the female macaque, the bacteria were found in the gastric mucosa and associated with emphysematous spaces in the gastric wall without associated inflammation. PCR and Sanger sequencing of amplicons were subsequently performed on GI contents and non-alimentary tissues from the 2 affected monkeys and on comparative samples from unaffected rhesus monkeys in the same facility and an adjacent primate facility. The cases were compared using the 2-tailed Fisher exact test (p-value at 95% confidence). PCR identified Sarcina in GI contents of both affected and unaffected monkeys (p = 0.6084) and in non-alimentary tissues of affected monkeys only (p = 0.0083). These results suggest that the presence of Sarcina sp. in non-alimentary tissues is associated with gastric distension, gas accumulation, and unexpected death in nonhuman primates.
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Affiliation(s)
- Laura M. Lee
- Department of Pathobiology, Auburn University, College of Veterinary Medicine, Auburn, AL, USA
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, WI, USA
| | - Leah A. Owens
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Lisa A. Krugner-Higby
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, WI, USA
| | - Melissa Graham
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, WI, USA
- Department of Agriculture, Trade and Consumer Protection, State of Wisconsin, Madison, WI, USA
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Megan Climans
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Kelsey Brown
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Allyson J. Bennett
- Harlow Center for Biological Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | - Jennifer Schaefer
- Harlow Center for Biological Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | - Kyle Meyer
- Harlow Center for Biological Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
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2
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Pinto NC, Nadal Bosch J, Ng-Wong YK, Menowsky M, Shine R, Malcom J, Moya M, Galindo J, Serna S. A Case Report of Candida-Induced Emphysematous Gastritis. Cureus 2023; 15:e47870. [PMID: 38022357 PMCID: PMC10681031 DOI: 10.7759/cureus.47870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Emphysematous gastritis is a rare entity that has not much literature available. It is known to manifest as a diffused wall inflammation and air within the wall of the stomach and has been associated with gas-forming organisms. We present a complex case of a middle-aged woman with a previous history of fulminant Clostridium difficile complicated with colectomy and diverting colostomy. She was admitted due to diabetic ketoacidosis, later complicated with worsening abdominal pain, and a CT scan of the abdomen and pelvis without contrast revealed findings consistent with ischemic bowel, severe pneumatosis intestinalis, and extensive portal venous gas. A stomach biopsy revealed hemorrhagic necrosis; a Gomori methenamine silver stain was compatible with fungal organisms, Candida species, correlating with Candida emphysematous gastritis. This case highlights the importance of early diagnosis of this syndrome in order to provide appropriate management, and early identification, to improve survival.
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Affiliation(s)
- Natalia C Pinto
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
| | - Jorge Nadal Bosch
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
| | - Yilen K Ng-Wong
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
| | - Michael Menowsky
- Emergency Medicine/Critical Care, Doctors Hospital at Renaissance/University of Texas Rio Grande Valley, Edinburg, USA
| | - Ryan Shine
- Surgery, University of Texas Rio Grande Valley, Edinburg, USA
| | - Javier Malcom
- Medical Information, Doctors Hospital at Renaissance, Edinburg, USA
| | - Mario Moya
- Radiology, Doctors Hospital at Renaissance, Edinburg, USA
| | | | - Samuel Serna
- Radiology, Doctors Hospital at Renaissance, Edinburg, USA
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3
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Vyskocil JV, Vyskocil JJ. Emphysematous Gastritis in a Patient With Recent COVID-19 Infection. Cureus 2023; 15:e43270. [PMID: 37692675 PMCID: PMC10492507 DOI: 10.7759/cureus.43270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Emphysematous gastritis, a rare pathology, causes gastric inflammation and intramural gas accumulation due to gas-forming microorganisms. Its diagnosis is made based on high clinical suspicion and confirmed by CT imaging of the stomach, which shows circumferential gas formation along the gastric wall. Early diagnosis and treatment are critical, as emphysematous gastritis is associated with a high mortality rate. Medical treatment consists of bowel rest, hydration, and intravenous broad-spectrum antibiotics. In the event of severe clinical decline despite medical treatment, surgery may be indicated. There may be an association between emphysematous gastritis and coronavirus disease 2019 (COVID-19) infection. We present a case of emphysematous gastritis in a patient with carbapenem-resistant Acinetobacter baumannii (CRAB) and a recent COVID-19 infection.
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Affiliation(s)
- Joseph V Vyskocil
- Critical Care, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - James J Vyskocil
- Critical Care, Advocate Aurora St. Luke's Medical Center, Milwaukee, USA
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4
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Angadi C, Chaurasia S, Priyadarshi M, Singh P, Basu S. Gastric Pneumatosis in a Neonate Born Late Preterm on the First Day of Life. J Pediatr 2023; 254:102-103. [PMID: 36334620 DOI: 10.1016/j.jpeds.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Chaitra Angadi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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5
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Muacevic A, Adler JR, Ooi G, Sritharan M. Conservative Management of Emphysematous Gastritis With Gastric Mucosal Ischaemia: A Case Report. Cureus 2023; 15:e34656. [PMID: 36755769 PMCID: PMC9902070 DOI: 10.7759/cureus.34656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/07/2023] Open
Abstract
Emphysematous gastritis is a rare condition historically associated with high mortality. It is characterised by gastric mural pneumatosis and portal venous gas, secondary to bacterial or fungal invasion. Given the rarity of the condition, there is little evidence to guide clinical decisions regarding whether a patient requires surgical resection. We describe the case of a 72-year-old male diagnosed with emphysematous gastritis, with endoscopic evidence of gastric fundus mucosal ischaemia. As there was no evidence of ischaemia extending to the serosa on exploratory laparotomy, gastrectomy was not performed, and the patient was managed conservatively. He subsequently made a full recovery, and was discharged without any further complications. This case demonstrates that in the absence of full-thickness gastric ischaemia, patients with emphysematous gastritis may be appropriate for conservative management without surgical resection.
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6
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Muacevic A, Adler JR, Dhande R, Mishra G, Gowda H. Emphysematous Gastritis: A Lethal Complication in a Patient With Pancreatitis. Cureus 2022; 14:e32882. [PMID: 36699748 PMCID: PMC9867913 DOI: 10.7759/cureus.32882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
A rare illness known as emphysematous gastritis is caused by bacteria that produce gas, such as Clostridium perfringens and Escherichia coli. In gastric emphysema and emphysematous gastritis, gas can be observed within the stomach wall. Gastric emphysema should be distinguished from emphysematous gastritis. Radiological imaging features and clinical presentation are used to identify emphysematous gastritis. The imaging technique of choice for this condition is computed tomography (CT). Emphysematous gastritis has a high risk of morbidity and mortality; hence, early diagnosis and care are crucial. We discuss a case of pancreatitis with emphysematous gastritis in a male presenting to the general surgery department with abdominal pain and vomiting. The patient was advised to undergo an ultrasound and computed tomography for further evaluation.
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7
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Muacevic A, Adler JR, Mantha PS, Ibrahim HS, Burstow MJ. Conservative Management of Suspected Emphysematous Gastritis. Cureus 2022; 14:e31995. [PMID: 36589171 PMCID: PMC9797770 DOI: 10.7759/cureus.31995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Emphysematous gastritis is a rare surgical condition. Although there is a lack of a common definition, the key features of its presentation include gastric emphysema on imaging and the presence of gas-forming organisms in the gastric mucosa. In this study, we report the case of an 80-year-old Caucasian male who presented with abdominal pain; a computed tomography scan demonstrated gastric emphysema (intra-mural air within the stomach). After upper gastrointestinal endoscopy excluded gross perforation, ulcer, and malignancy, the patient recovered to baseline with conservative management consisting of gastric rest (nil by mouth and nasogastric tube decompression), intravenous antibiotics, and intravenous proton pump inhibitor. Given the wide pathogenic mechanisms for gastric emphysema, we recommend a conservative but cautious approach if the patient does not demonstrate clinical features of hemodynamic instability, sepsis, and peritonitis.
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8
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Ogbue OD, Haddad A, Daw H. A Rare Case of Emphysematous Gastritis Secondary to Chemotherapy. Cureus 2021; 13:e18895. [PMID: 34804737 PMCID: PMC8599462 DOI: 10.7759/cureus.18895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Emphysematous gastritis is a rare medical condition characterized by the presence of intra-mural air in the stomach associated with portal venous air tracking to a variable degree. There are no established guidelines favoring surgery over medical management. We present a case of a 64-year-old Caucasian male with a history of stage four colon adenocarcinoma with peritoneal carcinomatosis, malignant ascites, and liver metastasis status post-three cycles of chemotherapy who presented to the emergency room with complaints of generalized abdominal pain, nausea, non-bilious vomiting, and melena stools. He was managed conservatively as a case of sepsis secondary to emphysematous gastritis and made a full recovery. To our knowledge, this is the first reported case of emphysematous gastritis in an adult with colon cancer. Although we cannot establish a causal link between his chemotherapy regimen and emphysematous gastritis, the combined effect of an immunosuppressive state caused by advanced malignancy and cytotoxic effects of chemotherapy are the probable risk factors in our patient. We described the possible mechanisms of mucosal disruption by fluorouracil and bevacizumab in our case. Despite historically having a poor prognosis, emphysematous gastritis can be managed conservatively on a case-by-case basis. Clinicians should be aware that chemotherapy can be a predisposing factor to developing this rare condition.
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Affiliation(s)
| | - Abdo Haddad
- Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, USA
| | - Hamed Daw
- Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, USA
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9
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Abstract
An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton-pump inhibitor and broad-spectrum antibacterial agents.
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Affiliation(s)
- Ryosuke Takase
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
- Department of Internal MedicineMarugame Medical CenterMarugameKagawaJapan
| | - Naoko Fukuda
- Department of Internal MedicineMarugame Medical CenterMarugameKagawaJapan
| | - Osamu Sui
- Department of RadiologyMarugame Medical CenterMarugameKagawaJapan
| | - Hideharu Hagiya
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
- Department of Internal MedicineMarugame Medical CenterMarugameKagawaJapan
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10
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Patel H, Buchanan F, Chai C. Candida-Induced Emphysematous Gastritis in a Multiple Myeloma Patient: Conservative Management With Favorable Outcome. Cureus 2021; 13:e18508. [PMID: 34754668 PMCID: PMC8569685 DOI: 10.7759/cureus.18508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Emphysematous gastritis is a rare, and often fatal, infection with unclear recommendations on management. We report the first documented case of emphysematous gastritis caused by Candida species in a patient on chemotherapy for multiple myeloma. Our patient, who presented with gastrointestinal symptoms was found to have gas in the stomach wall, peri-gastric, and portal veins on CT scan. Nasogastric tube cultures grew Candida albicans and Candida glabrata and the patient was treated with antibiotics and antifungals. Prompt recognition and conservative management led to a favorable outcome.
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Affiliation(s)
- Harshkumar Patel
- Internal Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Faith Buchanan
- Internal Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Christina Chai
- Internal Medicine/Hospital Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
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11
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Landa E, Vigandt E, Zhu Y, Ganim I. Gas in Your Stomach? A Curious Case of Complicated Emphysematous Gastritis With Concomitant Portal Venous Gas and Pneumoperitoneum Caused by Candida Glabrata. Cureus 2020; 12:e11650. [PMID: 33391891 PMCID: PMC7769497 DOI: 10.7759/cureus.11650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Emphysematous gastritis is a rare life-threatening infection caused by gas trapping within the gastric mucosal wall. It is diagnosed by radiological or operative findings most typically by CT scan of the abdomen. It is caused by gas-producing bacteria. Predisposing factors include but are not limited to alcohol intake, trauma, diabetes and surgery. Clinical presentation will typically include severe abdominal pain, abdominal distension and shock. Here we present the only reported case to our knowledge of Emphysematous gastritis with concomitant portal venous gas and pneumoperitoneum caused by Candida Glabrata.
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Affiliation(s)
- Eric Landa
- Internal Medicine, Unity Health, Searcy, USA
| | - Erika Vigandt
- Internal Medicine, Brooklyn Hospital Medical Center, Brooklyn, USA
| | - Ying Zhu
- Internal Medicine, Unity Health, Searcy, USA
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12
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Abstract
Gastric emphysema (GE) or gastric pneumatosis is a rare entity defined as air within the gastric wall. Etiologies include pneumothorax, instrumentation, infection, gastric wall ischemia, and mechanical injury. Several theories exist as to how the air disrupts the integrity of the gastric wall. These include a bacterial infection with Clostridium species and other gas-forming aerobic colonic bacilli, instrumentation with direct submucosal gastric wall injury, mechanical injury following increased intra-abdominal pressure, penetrating air through the mediastinum from increased intrapulmonary pressure or, gastric wall ischemia, which may be secondary to an underlying process. The diagnostic test of choice is CT of the abdomen. A hypodense linear fringe on the gastric wall is seen in GE, associated with gastric distention without thickening. In emphysematous gastritis, there is gastric wall thickening. There are no standardized guidelines for GE, but most cases have a good prognosis with a spontaneous resolution with conservation treatment. However, emphysematous gastritis management requires aggressive treatment due to the mortality rate of emphysematous gastritis approaching 60%. Patients are often considered for surgical intervention with total gastrectomy, given that active infection could delay or prevent healing. It is imperative to differentiate GE and emphysematous gastritis and understand the underlying pathogenesis as clinical outcomes are vastly different.
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Affiliation(s)
- Jonathan Vincent Reyes
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Raju S Alluri
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Ahmed Al-Khazraji
- Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Tasur Seen
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Aaron Walfish
- Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
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13
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Alataby H, Daniel M, Bibawy J, Diaz K, Nfonoyim J. Gastric Emphysema and Hepatic Portal Vein Gas as Complications of Noninvasive Positive Pressure Ventilation. Cureus 2020; 12:e9086. [PMID: 32789036 PMCID: PMC7417069 DOI: 10.7759/cureus.9086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Gastric emphysema (GE) in association with hepatic portal vein gas (HPVG) is a rare, benign medical condition that is very seldom caused by noninvasive positive pressure ventilation (NIPPV). This report describes a patient who developed GE along with gastric vein gas and HPVG, most likely due to multiple episodes of vomiting in combination of using bilevel positive airway pressure (BiPAP), a form of NIPPV. The patient responded to conservative treatment with intravenous fluids, pantoprazole, and the urgent cessation of BiPAP and oral intake.
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Affiliation(s)
- Harith Alataby
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Mina Daniel
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Joseph Bibawy
- Radiology, Richmond University Medical Center, Staten Island, USA
| | - Keith Diaz
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
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14
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Mehmood A, Essrani R, Parvataneni S, Iqbal U. Unique Case of Gastroenteritis Presenting as Pneumatosis Intestinalis With Emphysematous Gastritis and Portal Vein Gas: Do Not Take Gastroenteritis Lightly. Cureus 2020; 12:e8765. [PMID: 32676256 PMCID: PMC7362622 DOI: 10.7759/cureus.8765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Pneumatosis intestinalis (PI) consists of multiple, thin, gas-filled cysts in the wall of the gastrointestinal (GI) tract. It is an uncommon entity that can involve any gastrointestinal site from the stomach to the rectum. Isolated stomach involvement is rare. PI can represent a broad spectrum of diseases with variable prognoses. We present the case of a patient who was admitted with gastroenteritis-like symptoms. He remained hemodynamically stable, and on further imaging with contrast-enhanced computed tomography of the abdomen and pelvis, air was found in the portal vein and gastric wall, with minimal thickening of the proximal small bowel concerning for emphysematous gastroenteritis. Further workup results were negative, including blood cultures, stool studies, Clostridium difficile toxins, and lactic acid levels. The patient was managed nonoperatively and recovered without serious complications. Our case is unique in terms of the presence of air in the portal vein, which would otherwise suggest the possible spread of infection across the bowel wall.
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Affiliation(s)
- Asif Mehmood
- Internal Medicine, Geisinger Medical Center, Danville, USA
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Rajesh Essrani
- Internal Medicine, Geisinger Medical Center, Danville, USA
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | | | - Umair Iqbal
- Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, USA
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15
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Riaz S, Kudaravalli P, Saleem SA, Sapkota B. Emphysematous Gastritis: A Real Indication for Emergent Surgical Intervention? Cureus 2020; 12:e8106. [PMID: 32426198 PMCID: PMC7228801 DOI: 10.7759/cureus.8106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 11/05/2022] Open
Abstract
Emphysematous gastritis is a rare disease with gastric inflammation and intramural gas formation due to gas-forming microorganisms. It is diagnosed based on clinical presentation and imaging findings of gas in the gastric wall. Computed tomography is the preferred imaging modality. Early diagnosis and management are important since emphysematous gastritis is associated with high rates of morbidity and mortality. We present a case of emphysematous gastritis, which was successfully managed conservatively through early diagnosis and prompt treatment.
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Affiliation(s)
- Sana Riaz
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Pujitha Kudaravalli
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Sheikh A Saleem
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
| | - Bishnu Sapkota
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
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16
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Madokoro S, Yanagawa Y, Nagasawa H, Takeuchi I, Oode Y. Damage Control Management for Thoracic Trauma with Cardiac Arrest Complicated by Emphysematous Gastritis and Cystitis. Cureus 2020; 12:e7102. [PMID: 32231897 PMCID: PMC7098417 DOI: 10.7759/cureus.7102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 78-year-old man was found unconscious after sliding from a rock. His history included hypertension, atrial fibrillation and cerebral infarction requiring warfarin. On arrival, he received six units of blood type O transfusion and vitamin K in an emergency room (ER) due to hemorrhagic shock. His systolic blood pressure temporarily increased to 100 mmHg, and he underwent traumatic pan scan revealing occipital fracture, cerebral contusion, and cervical and multiple left rib fractures with left-dominant bilateral hemothorax. He re-entered a shock state after the examination and underwent transfusion again, but he then entered cardiac arrest. He underwent damage control surgery in the ER and obtained spontaneous circulation. The postoperative course was eventful, but he eventually obtained a survival outcome. Damage control surgery may be beneficial, even in cases of severe thoracic blunt trauma; however, postoperative infections may cause severe problems.
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Affiliation(s)
- Shunsuke Madokoro
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Youichi Yanagawa
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Hiroki Nagasawa
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Ikuto Takeuchi
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Yasumasa Oode
- Intensive and Emergency Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
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17
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Malik F, Lattanzio N, Veloso K, Nfonoyim J. A case report of gastric emphysema induced by noninvasive positive airway pressure. J Community Hosp Intern Med Perspect 2019; 9:244-246. [PMID: 31258866 PMCID: PMC6586125 DOI: 10.1080/20009666.2019.1618669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
Gastric emphysema is a rare medical condition in which air penetrates any layer of the gastric wall (mucosa, submucosa, muscle layer, or serosa) due to a noninfectious source. It is essential to differentiate this from a life-threatening condition known as emphysematous gastritis. These two conditions have a similar presentation, and therefore, it is difficult to differentiate the two on imaging. Bi-level positive airway pressure (BiPAP) is a noninvasive intervention for selected patients in respiratory distress. This intervention uses positive airway pressure to prevent endotracheal intubation. The commonly noted side effects of positive airway pressure are dry mouth and oral irritation. This is the first case, to our knowledge, of gastric emphysema directly originating from BiPAP administration. It was diagnosed on imaging as pneumatosis intestinalis and emphysematous gastritis but clinical presentation was benign. The condition resolved immediately after discontinuation of BiPAP.
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Affiliation(s)
- Fahad Malik
- Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Natalia Lattanzio
- Saint George University School of Medicine, True Blue, Grenada, West Indies
| | - Karen Veloso
- Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Jay Nfonoyim
- Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
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Nehme F, Rowe K, Nassif I. Emphysematous gastritis with hepatic portal venous gas: a shift towards conservative management. BMJ Case Rep 2017; 2017:bcr-2017-219651. [PMID: 28566409 DOI: 10.1136/bcr-2017-219651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Fredy Nehme
- Department of Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
| | - Kyle Rowe
- Department of Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
| | - Imad Nassif
- Department of Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
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20
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Mahmoudi A, Maâtouk M. [A rare and fulminant form of gastritis: emphysematous gastritis]. Pan Afr Med J 2016; 22:58. [PMID: 26834911 PMCID: PMC4725653 DOI: 10.11604/pamj.2015.22.58.7910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ammar Mahmoudi
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Mezri Maâtouk
- Service d'Imagerie Médicale, CHU Fattouma Bourguiba de Monastir, Tunisie
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Jehangir A, Rettew A, Shaikh B, Bennett K, Qureshi A, Jehangir Q. A case report of emphysematous gastritis in a diabetic patient: favorable outcome with conservative measures. J Community Hosp Intern Med Perspect 2015; 5:28010. [PMID: 26333858 PMCID: PMC4558277 DOI: 10.3402/jchimp.v5.28010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/24/2015] [Accepted: 05/11/2015] [Indexed: 11/14/2022] Open
Abstract
Emphysematous gastritis (EG) is a rare cause of abdominal pain, which should be differentiated from gastric emphysema. It is hypothesized to result from air-producing microorganisms in patients with underlying predisposing factors. Because of the non-specific presentation of EG, it is diagnosed radiographically. CT scan is the diagnostic modality of choice that typically reveals irregular, mottled appearance of the air in the thickened gastric wall and in the portal vein in the liver. We report a rare case of EG in a male with a history of diabetes mellitus who presented to the emergency department with diarrhea, nausea, vomiting, and epigastric pain. On examination, he was hypotensive and had mild tenderness in the epigastrium. Laboratory tests revealed leukocytosis, elevated lactate, anion gap metabolic acidosis, and acute kidney injury. A non-contrast CT abdomen revealed findings consistent with EG. Even though mortality rate in access of 60% have been reported without prompt surgical intervention in EG, recent literature suggests favorable prognosis with conservative measures in patients without an overt surgical indication. Our patient was also managed conservatively with IV antibiotics and gradual advancement of diet and had complete resolution of symptoms over the ensuing few days. The factors that correlate with a poor prognosis include elevated serum lactate, serum creatinine, and concomitant pneumatosis in small bowel and colon.
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Affiliation(s)
- Asad Jehangir
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA;
| | - Andrew Rettew
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Bilal Shaikh
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Kyle Bennett
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Anam Qureshi
- King Edward Medical University, Lahore, Pakistan
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