CASE REPORT: EMPHYSEMATOUS GASTRITIS ASSOCIATED WITH PELVIC ABSCESS

Abstract

Emphysematous gastritis (EG) is an uncommon ailment of the stomach caused by gas-forming microbes, distinguished by the unique presentation of intramural gas bubbles on computed tomography scan (CT-Scan). Over the years, the management of EG has mainly shifted from urgent exploratory laparotomy, with or without gastrectomy, to a more conservative approach, such as esophago gastroduodenoscopy, and a complete course of broad-spectrum antibiotics.  While opting for conservative treatment has improved the survival rate, EG continues to be a disease of high mortality, often elusive in its presentation and difficult to diagnose early. Traditionally, EG is often associated with other comorbidities such as diabetes, cancer, immunosuppression, chronic obstructive pulmonary disease and renal failure, the case we present in this report belongs to a rare demographic of an otherwise healthy fifteen year old girl. A fifteen year old girl presents to the Emergency Department with the complaint of severe epigastric abdominal pain and abdominal distension for five days. She was vitally stable and well-oriented but visibly in discomfort due to her pain. Blood tests were unremarkable save for a high level of lipase, leading us to suspect pancreatitis. Eventual CT Scan with IV and oral contract depicted pelvic collection and air in the stomach wall making the diagnosis of emphysematous gastritis (EG).