Une forme rare et fulminante de gastrite: la gastrite emphysémateuse

Abstract

Emphysematous gastritis is characterized by the presence of gas in the stomach wall and it is due to infection by "gas-producing" germs. It has a poor prognosis associated with high mortality rates, requiring early diagnosis and treatment. The patient’s clinical picture is not specific. The diagnosis is often radiological. Emergency surgical treatment is recommended in case of necrosis, perforation, peritonitis or rapid deterioration in patient’s condition under medical treatment. We report the case of a 79-year old man, with a personal history of alzheimer lasting for 3 years; he was diabetic, treated with oral antidiabetic agents over a period of 30 years. He presented to the emergency department with epigastric pain of 48 hours of evolution. On examination, he was septic in febrile state (39,5 ºC), chills and tendency to collapse. He was polypneic with abdominal defense at the supra-umbilical level. There was a yperleukocytosis of 25 000/mm3 , a CRP value of 280 mg/l and metabolic acidosis. Abdominal CT scan showed the presence of gas in the stomach wall and confirmed the diagnosis of gastritis emphysematous. Digestive system vascular axes, particularly the celiac trunk, were permeable. There was no portal venous gas. A broad spectrum antibiotic therapy active against gram negative bacteria and anaerobes was started and patient preparation for emergency surgery was initiated but the patient died of multiple organ failure associated with acute respiratory distress syndrome an hour after abdominal CT scan examination.

Pan African Medical Journal 2016; 24