Emphysematous Gastritis

This is a remarkable case.

The patient with end stage renal disease presented with abdominal pain and distention.

While in the hospital, the patient developed respiratory failure and hypotension. The patient was thought to have pneumonia - the chest XR showed a significant consolidation on the left.

While in the ICU the patient progressively decompensated and required aggressive supportive care.

The chest XR showed what looks like free air under the left diaphragm (black arrows on the upper image above)

CT abdomen revealed gastric emphysema (white arrows on the bottom image) consistent with emphysematous gastritis likely due to gastric ischemia.

The patient was deemed to be a poor surgical candidate. After a discussion with the family care was withdrawn and the patient died.

The exact etiology of gastric ischemia in this case remains unclear. The likely cause is relative gastric hypoperfusion due to hypotension and pre-existing vascular disease (the patient was a smoker).