Ogbue Olisaemeka D, Haddad Abdo, Daw Hamed
Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, USA.
Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, USA.
Cureus. 2021 Oct 19;13(10):e18895. doi: 10.7759/cureus.18895. eCollection 2021 Oct.
Emphysematous gastritis is a rare medical condition characterized by the presence of intra-mural air in the stomach associated with portal venous air tracking to a variable degree. There are no established guidelines favoring surgery over medical management. We present a case of a 64-year-old Caucasian male with a history of stage four colon adenocarcinoma with peritoneal carcinomatosis, malignant ascites, and liver metastasis status post-three cycles of chemotherapy who presented to the emergency room with complaints of generalized abdominal pain, nausea, non-bilious vomiting, and melena stools. He was managed conservatively as a case of sepsis secondary to emphysematous gastritis and made a full recovery. To our knowledge, this is the first reported case of emphysematous gastritis in an adult with colon cancer. Although we cannot establish a causal link between his chemotherapy regimen and emphysematous gastritis, the combined effect of an immunosuppressive state caused by advanced malignancy and cytotoxic effects of chemotherapy are the probable risk factors in our patient. We described the possible mechanisms of mucosal disruption by fluorouracil and bevacizumab in our case. Despite historically having a poor prognosis, emphysematous gastritis can be managed conservatively on a case-by-case basis. Clinicians should be aware that chemotherapy can be a predisposing factor to developing this rare condition.
气肿性胃炎是一种罕见的医学病症，其特征是胃壁内存在气体，并伴有不同程度的门静脉气体播散。目前尚无明确的指南支持手术治疗优于药物治疗。我们报告一例64岁的白种男性患者，有四期结肠腺癌病史，伴有腹膜癌转移、恶性腹水和肝转移，在接受三个周期化疗后，因出现全身腹痛、恶心、非胆汁性呕吐和黑便而就诊于急诊室。他被作为气肿性胃炎继发脓毒症的病例进行保守治疗，并完全康复。据我们所知，这是首例在成年结肠癌患者中报道的气肿性胃炎病例。虽然我们无法确定其化疗方案与气肿性胃炎之间的因果关系，但晚期恶性肿瘤导致的免疫抑制状态和化疗的细胞毒性作用的联合效应可能是我们这位患者的危险因素。我们在病例中描述了氟尿嘧啶和贝伐单抗导致黏膜破坏的可能机制。尽管气肿性胃炎以往预后较差，但可根据具体病例进行保守治疗。临床医生应意识到化疗可能是发生这种罕见病症的一个诱发因素。
