Emphysematous gastritis: The diagnostic challenges and variable outcomes

Emphysematous gastritis (EG) is a life-threatening condition characterized by gas within the gastric wall, typically caused by infectious gas-forming organisms. With nonspecific clinical presentations and a high mortality rate, EG poses significant diagnostic and therapeutic challenges. Diagnostic imaging, especially computed tomography (CT), is instrumental in diagnosing and evaluating progression of EG. We present 2 cases of EG with differing outcomes. The first patient, an 82-year-old male with multiple comorbidities, was managed conservatively with gastric decompression, intravenous antibiotics, and supportive care, leading to recovery. The second patient, an 81-year-old male with gastric adenocarcinoma, rapidly deteriorated due to sepsis and suspected gastric perforation, succumbing despite aggressive treatment. These findings emphasize the importance of early diagnosis and individualized management strategies. Both patients received prompt abdominal CT scans revealing hallmark features such as gastric pneumatosis and portal venous gas. Multiple entities share similar radiographic features such as intramural gas but differ in their etiology and clinical significance. Distinguishing between different radiographic findings provides critical clues for differentiating EG from its mimics, enabling timely and appropriate intervention. The variability in outcomes underscores the need for further research to improve diagnostic and treatment protocols for this rare and severe condition.