Two Cases of Emphysematous Gastritis

Two cases of emphysematous gastritis are reported here. Case 1: The patient was a 46-year-old man who ingested nitrate (60%, 150 ml) in suicide attempt. On the 17th day of hospitalization, emergency surgery was performed for perforated peritonitis with shock and intraperitoneal bleeding. The lower esophageal region and the whole stomach were necrotic. Bubble-and streak-like collections of gas appeared at the 6th hospitalized day in the gastric wall on plain abdominal X-ray film. Case 2: The patient was a 72-old woman who was pancreaticoduodenectomized for duodenal papilla cancer. Hematemesis and bleeding from pancreatico-jejunal anastomosis appeared at the 18th post operative day (P.O.D.). Necrosis of the residual stomach and pancreas and intra-splenic gas appeared on abdominal computed tomography at the 25th P.O.D. Then, emergency laparotomy was performed. Plain X-ray on the 21st P.O.D. showed gas shadows on the intragastric wall indicating bubbly and frothy gas mixed with ingesta. The gas was due to infection of the necrotic tissues caused by disturbnce of circulation and corrosion. In our cases, the gas shadows on plain X-ray film appeared before the clinical signs and the symptoms of gastric necrosis and perforation. So in this disease early diagnosis may be possible by plain X-ray film, and serious illness may be avoided.