Emphysematous Gastritis in a Hemodialysis Patient

Madhuri Yalamanchili, MD, William Cady, MD

Disclosures

South Med J. 2003;96(1) 

In This Article

Abstract and Introduction

Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated systemic toxicity. We report a case of emphysematous gastritis in a 43-year-old diabetic patient receiving hemodialysis and review 41 cases published since 1889. The most common predisposing factors included ingestion of corrosive substances, alcohol abuse, abdominal surgery, diabetes, and immunosuppression. Diagnosis is based on clinical presentation of acute abdomen with associated features of systemic toxicity. The most commonly involved organisms were streptococci (nine cases), Escherichia coli (nine cases), Enterobacter species (six cases), Clostridium welchii (four cases), and Staphylococcus aureus (four cases). Computed tomography (CT) is the diagnostic procedure of choice. The mortality rate was 61% (25 of 41 patients). Gastric contractures after recovery were noted in 10% (4 of 41 patients). Antimicrobial therapy with antibiotics covering gram-negative organisms and anaerobes, and surgery in appropriate cases may enhance survival.

Emphysematous gastritis is characterized by air in the wall of the stomach due to invasion by gas-forming microorganisms. This entity is rare, with only 41 cases reported so far in the English-language literature. Because emphysematous gastritis is a lethal condition, early diagnosis and early treatment with antibiotics and surgery are necessary to avoid adverse outcome. We report a case of emphysematous gastritis diagnosed by performing computed tomography (CT) in a patient who was receiving hemodialysis. Our case is unique because this condition has not previously been reported in a hemodialysis patient.

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