Conservative management of emphysematous gastritis with necrotic ulceration

A man in his 70s from a nursing facility with multiple comorbidities presented with acute onset nausea, vomiting and septic shock. CT abdomen revealed gastric pneumatosis consistent with emphysematous gastritis (EG). He was treated in the intensive care unit with broad-spectrum antibiotics, vasopressors and supportive care; oesophagogastroduodenoscopy showed extensive fundal ulceration with necrotic mucosa. Echocardiography demonstrated severe, reversible left ventricular systolic dysfunction consistent with septic cardiomyopathy. With conservative management (antibiotics, gastric decompression, intravenous fluids, pressor support and steroid therapy), the patient improved without surgical intervention. His clinical course and recovery illustrate the importance of early diagnosis and multidisciplinary management in EG.