Emphysematous Gastritis with Air in Portal Venous System

Emphysematous gastritis is a rare but severe form of phlegmonous gastritis caused by gastric mucosal disruption and infection of stomach wall by gas-forming bacteria. Ingestion of corrosive substances is the most common predisposing factor, followed by alcohol abuse, abdominal surgery, diabetes and immunosuppression. Patients usually present with abdominal pain, vomiting, diarrhea, constipation and/or gastro-intestinal hemorrhage. Characteristic radiological findings include presence of gas in the gastric wall. Management of this condition includes broad-spectrum antibiotics and supportive therapy. Outcome of emphysematous gastritis is frequently fatal due to septic shock and multi-organ failure. We report a case of a 65 years old male who presented with fever and upper abdominal tenderness. He had history of uncontrolled diabetes and chronic alcohol intake. Radiological investigations revealed air within the gastric wall, portal vein, liver and spleen. Despite initial improvement with conservative management, patient succumbed due to sepsis and shock.