Emphysematous gastritis secondary to gastric infarction

We report a 72-yr-old female hospitalized for an upper gastrointestinal hemorrhage who developed emphysematous gastritis and gas in the portal vein. Endoscopy of the stomach revealed severe circumferential erythema, erosions, exudates, and friability of irregularly thickened proximal gastric folds. The patient became septic on the third day of hospitalization and deteriorated rapidly. Computerized tomographic scan of the abdomen revealed extensive collections of gas within the gastric wall and in the intrahepatic portal veins. Autopsy revealed severe atherosclerotic disease and a stenosis with thrombus at the origin of the celiac artery. Clostridium welchii was isolated in blood cultures prior to the patient's death. Postmortem review of endoscopic biopsies of the stomach revealed changes of incipient gastric infarction.