Emphysematous gastritis with extensive portal venous gas and endoscopic mucosal necrosis: gastric preservation despite an alarming presentation.
5 affiliations
- 1Department of General Surgery, G. Paolo II Hospital, Via Senatore Arturo Perugini, 88046 (CZ), Lamezia Terme, Italy.
- 2Department of Medical and Surgical Sciences, University of Plovdiv, 15A Vasil Aprilov Boulevard, 4002 Plovdiv, Bulgaria.
- 3Department of Anesthesia, G. Paolo II Hospital, Lamezia Terme, Via Senatore Arturo Perugini, 88046 (CZ), Italy.
- 4Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, Località Germaneto, 88100 (CZ), Catanzaro, Italy.
- 5Digestive Endoscopy Unit, Department of Gastroenterology, G. Paolo II Hospital, Via Senatore Arturo Perugini, 88046 (CZ), Lamezia Terme, Italy.
Abstract
Emphysematous gastritis (EG) is a rare, potentially life-threatening condition. Extensive gastric pneumatosis and portal venous gas may suggest irreversible ischemia, although radiological severity and mucosal injury do not necessarily indicate transmural necrosis. A 70-year-old man presented with acute epigastric pain and vomiting. Computed tomography (CT) demonstrated extensive gastric and duodenal pneumatosis with portomesenteric venous gas but patent visceral arteries. Immediately after CT, he developed cardiac arrest, with return of spontaneous circulation after approximately 14 min. Emergency laparoscopy showed a viable stomach without perforation or transmural necrosis, whereas intraoperative endoscopy demonstrated extensive necrotic-appearing gastric mucosa. Gastrectomy was therefore avoided. Follow-up CT 4 days later showed complete resolution of pneumatosis and portomesenteric venous gas. The patient subsequently died from post-anoxic neurological injury and multiorgan failure. Surgical exploration and gastric resection should remain distinct decisions in severe EG, integrating imaging, endoscopy, and direct assessment of gastric viability.
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BibTeX
@article{caruso2026emphysematous,
title = {{Emphysematous gastritis with extensive portal venous gas and endoscopic mucosal necrosis: gastric preservation despite an alarming presentation.}},
author = {Ettore Caruso and Carmine Gabriele and Denise Gambardella and Roccantonio Pellegrino and Maria Bonaddio and Luigi Strangis and Francesca Ibba and Martina De Luca and Martina Saragò and Martina Nicoletti and Laura Rizzo and Francesca Vescio and Vittorio Tedesco and Aurora Somma and Giuseppe Bonadio and Gianlorenzo Schicchi and Angelo Aldo Schicchi and Manfredo Tedesco},
journal = {Journal of surgical case reports},
year = {2026},
month = oct,
doi = {10.1093/jscr/rjag942},
url = {https://europepmc.org/article/MED/42899261},
note = {CC BY},
}
RIS
TY - JOUR
TI - Emphysematous gastritis with extensive portal venous gas and endoscopic mucosal necrosis: gastric preservation despite an alarming presentation.
AU - Ettore Caruso
AU - Carmine Gabriele
AU - Denise Gambardella
AU - Roccantonio Pellegrino
AU - Maria Bonaddio
AU - Luigi Strangis
AU - Francesca Ibba
AU - Martina De Luca
AU - Martina Saragò
AU - Martina Nicoletti
AU - Laura Rizzo
AU - Francesca Vescio
AU - Vittorio Tedesco
AU - Aurora Somma
AU - Giuseppe Bonadio
AU - Gianlorenzo Schicchi
AU - Angelo Aldo Schicchi
AU - Manfredo Tedesco
PY - 2026
DA - 2026/10/19
JO - Journal of surgical case reports
DO - 10.1093/jscr/rjag942
UR - https://europepmc.org/article/MED/42899261
AB - Emphysematous gastritis (EG) is a rare, potentially life-threatening condition. Extensive gastric pneumatosis and portal venous gas may suggest irreversible ischemia, although radiological severity and mucosal injury do not necessarily indicate transmural necrosis. A 70-year-old man presented with acute epigastric pain and vomiting. Computed tomography (CT) demonstrated extensive gastric and duodenal pneumatosis with portomesenteric venous gas but patent visceral arteries. Immediately after CT, he developed cardiac arrest, with return of spontaneous circulation after approximately 14 min. Emergency laparoscopy showed a viable stomach without perforation or transmural necrosis, whereas intraoperative endoscopy demonstrated extensive necrotic-appearing gastric mucosa. Gastrectomy was therefore avoided. Follow-up CT 4 days later showed complete resolution of pneumatosis and portomesenteric venous gas. The patient subsequently died from post-anoxic neurological injury and multiorgan failure. Surgical exploration and gastric resection should remain distinct decisions in severe EG, integrating imaging, endoscopy, and direct assessment of gastric viability.
SN - 2042-8812
ER -