An 82-year-old man presented with bloating and generalized abdominal pain, accompanied by vomiting (dark in color, with an aspect of retention vomiting) and diarrheic stools. A plain abdominal x-ray (Fig. 1) showed air in the gastric wall and bowel segment dilation. An abdominal computed tomography (CT) scan was ordered (Fig. 2) that revealed intramural gas associated with gastric dilation, pneumoperitoneum (Fig. 3), and gas in the portal vein (Fig. 4). An exploratory laparotomy was performed, finding a distended stomach with gas bubbles in its serosa and no signs of transmural necrosis or perforation. Intraoperative gastroscopy identified ulcerated-necrotic mucosa with no spontaneous bleeding on the posterior surface, body, and greater curvature. Given those findings, no further surgical act was carried out. Lactobacillus jensenii was isolated in blood cultures and treated with meropenem + linezolid. The patient progressed favorably, with improvement in the control abdominal CT scan, and was released from the hospital. Emphysematous gastritis is a rare pathology produced by the translocation of gas-producing microorganisms in the walls of the stomach. The causal agent cannot be isolated in up to 42.4%1 of cases and there is a 60% mortality rate.2 CT is the diagnostic study of choice and is essential for making early diagnosis and implementing the vital support treatment with broad-spectrum antibiotics. Surgery is only required if there is no response to conservative treatment or in cases of severe sepsis or gastric perforation.3

Figure 1.

Plain abdominal x-ray showing gastric dilation with intramural gas (arrows) and small bowel segment dilation.

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Figure 2.

Luminogram from an abdominal CT scan with iv contrast medium. Intraparietal gas forming a dilated gastric silhouette is shown, as well as the bowel segment dilation.

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Figure 3.

Axial view of the abdominal CT scan with iv contrast medium showing abundant quantities of intraparietal gas in the stomach, small bowel segment dilation with a maximum caliber of 4.3 cm, and a pneumoperitoneum of moderate quantity adjacent to the gastric body and anterior abdominal wall.

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Figure 4.

Axial view of the abdominal CT scan with iv contrast medium showing abundant gas in the portal vein (portal pneumatosis).

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