Hematemesis and severe abdominal pain • Xray of the Week 2016
A 33 year old female with chronic renal failure and kidney transplant presented to the Emergency Department with severe abdominal pain and hematemesis. What is the diagnosis?
Figure 1. Axial (A) and coronal (B) non-contrast CT of the abdomen and pelvis.
Figure 2. Axial (A) and sagittal (B) non-contrast CT of the abdomen and pelvis. Red arrow: gas in the wall of the stomach. Green arrow: Renal transplant.
Emphysematous gastritis is a rare cause of gastric emphysema, and usually refers to infectious gastritis. The condition is due to mucosal disruption and gastric wall infection with gas producing organisms such as Escherichia coli and Clostridium perfringens. Although gas may be visualized with plain radiographs, CT is the best modality for detection of intramural gas. Radiologist play vital role in early detection of the disease. Treatment includes broad spectrum intravenous antibiotics and IV fluids. Surgery may be required in cases of gastric infarction, perforation or failed medical treatment. The mortality rate is high (60%–80%) even with aggressive medical or surgical management.
References: 1. Wong YY, Chu WC. Emphysematous gastritis associated with gastric infarction in a patient with adult polycystic renal disease: CT diagnosis. AJR Am J Roentgenol. 2002;178 (5): 1291 2. Loi TH, See JY, Diddapur RK, Issac JR. Emphysematous gastritis: a case report and a review of literature. Ann Acad Med Singapore. 2007;36:72-3.
3. Viswanath S, Jain AKC. Emphysematous gastritis: A rare diagnosis with unique presentation. OA Case Reports 2014 Feb 25;3(2):11.
4. Fidvi SA, Klein SA. Emphysematous gastritis. Applied Radiology. 2002;31(3):1-2.
5. Kussin SZ, Henry C, Navarro C, Stenson W, Clain DJ. Gas within the wall of the stomach: report of a case and review of the literature. Dig Dis Sci 1982; 27:949–954.
6. Grayson DE, Abbott RM, Levy AD, et al. Emphysematous Infections of the Abdomen and Pelvis: A Pictorial Review. RadioGraphics 2002; 22:543–561.
Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator.
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