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Emphysematous gastritis
Gastritis enfisematosa
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Laboratory-tests showed high inflammatory parameters with no microbiological isolation. Computed tomography-scan revealed gas dissecting gastric wall layers. (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 1</a>a with black arrows and fig 1b with red arrows showing gas all around gastric wall). He started parenteral feeding and intravenous antibiotics (piperacillin-tazobactam and metronidazole), with overall improvement.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Emphysematous gastritis, a rare and severe entity, is characterized by gastric mucosal disruption by gas, needs a high level of suspicion for rapid diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinically non-specific, arises with abdominal pain, diarrhea, nausea, vomiting and occasionally occurring hematemesis and melena.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Predisposing factors are alcohol abuse, diabetes, non-steroids-anti-inflammatory, gastric adenocarcinoma, abdominal surgery, pancreatitis and gastroenteritis, among others. Most isolated microorganisms are Streptococci, <span class="elsevierStyleItalic">Escherichia coli</span>, Enterobacter-species, <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> and <span class="elsevierStyleItalic">Clostridium perfringens</span>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Intravenous antibiotics (covering anaerobes and gram-negative bacilli), hydration and nutrition are gold standard treatment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Specific situations (perforation, necrosis) require surgery. 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