Mansour Hussein, Ali Jawad, Swamy Anupama, Leahy Anthony
Gastroenterology, West Hertfordshire Teaching Hospitals NHS Trust, London, GBR.
Pathology, West Hertfordshire Teaching Hospitals NHS Trust, London, GBR.
Cureus. 2024 Aug 3;16(8):e66084. doi: 10.7759/cureus.66084. eCollection 2024 Aug.
Emphysematous gastritis is a rare condition with a high mortality rate. We present a rare case of haemorrhagic emphysematous gastritis in a 70-year-old woman with a background of relapsed endometrioid ovarian cancer previously treated with chemotherapy and recent prednisolone use. A CT scan showed a grossly distended stomach with gas in the stomach wall and gas in the gastric and portal veins in the liver. The duodenum and small bowel were not dilated, suggesting gastric outlet obstruction potentially secondary to serosal deposits. Endoscopic evaluation showed an ischaemic oesophagus and posterior wall of the stomach, with necrosis of the greater curve. Histology showed complete loss of the gastric epithelium along with transmural necrosis along with intense acute and chronic inflammation. She was treated conservatively, as she was not fit for surgery due to her co-morbidities. She symptomatically improved and was discharged under the palliative care team. There are no current clear guidelines on treatment approaches. After a patient is haemodynamically stabilised, treatment options currently include surgical intervention (gastrectomy) or conservative options (fluid resuscitation, nasogastric decompression, broad-spectrum antibiotics/antifungals and supportive management). Historically, emphysematous gastritis was conventionally managed surgically. There has been a shift towards conservative management in recent literature, reporting good patient outcomes in patients successfully managed without surgical intervention.
气肿性胃炎是一种罕见疾病，死亡率很高。我们报告了一例罕见的出血性气肿性胃炎病例，患者为一名70岁女性，有复发性子宫内膜样卵巢癌病史，此前接受过化疗，近期使用过泼尼松龙。CT扫描显示胃明显扩张，胃壁内有气体，肝脏内胃静脉和门静脉内有气体。十二指肠和小肠未扩张，提示可能继发于浆膜下沉积物的胃出口梗阻。内镜检查显示食管和胃后壁缺血，大弯侧坏死。组织学检查显示胃上皮完全丧失，伴有透壁坏死以及强烈的急性和慢性炎症。由于其合并症，她不适合手术，因此接受了保守治疗。她的症状有所改善，并在姑息治疗团队的照料下出院。目前尚无明确的治疗方法指南。在患者血流动力学稳定后，目前的治疗选择包括手术干预（胃切除术）或保守治疗（液体复苏、鼻胃管减压、广谱抗生素/抗真菌药物及支持治疗）。从历史上看，气肿性胃炎传统上采用手术治疗。最近的文献显示治疗趋势已转向保守治疗，报道称未接受手术干预而成功治疗的患者预后良好。
