Emphysematous Gastritis Associated With Hepatic Portal Venous Gas Accumulation

A 53-year-old man with diabetes and hypertension was hospitalized with a diagnosis of acute cerebral infarction and was receiving enteral nutrition via a gastric tube due to dysphagia. Computed tomography (CT) performed for sudden vomiting showed a marked accumulation of gas in the gastric wall, portal, hepatic, and perigastric veins (Figure A). Emergency esophagogastroduodenoscopy revealed an accumulation of yellowish mucus necrotic material with numerous bubbles from the gastric cardia and antrum. In addition, findings as various as redness, edema, erosion, ulceration, and granulation were observed in the mucosa (Figure B-D). He was thus diagnosed with emphysematous gastritis, had his gastric tube removed, and was treated conservatively with fasting and a histamin-2 receptor blocker. Gastric fluid culture revealed Candida albicans. CT and esophagogastroduodenoscopy 10 days later showed the disappearance of the gas and improvement of the mucosa, respectively. His clinical course was uneventful thereafter. While rare, emphysematous gastritis is a serious condition with a mortality rate of 60% to 80%, whose diagnosis is easily established based on CT findings, but whose hyperacute-phase endoscopic findings remain largely unknown, despite being necessary for determining treatment strategies. The endoscopic images provided should offer a clear presentation of the case and serve as reference for endoscopists.