Korean J Gastroenterol.  2012 Nov;60(5):315-319. 10.4166/kjg.2012.60.5.315.

A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension

• Kim T
• Kim HU
• Song HJ

• KMID: 1775797
• DOI: http://doi.org/10.4166/kjg.2012.60.5.315

Abstract

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.

Keyword

Emphysema; Emphysematous gastritis; Anorexia nervosa; Superior mesenteric artery syndrome; Gastric dilatation

MeSH Terms

Acute Disease
Adolescent
Anorexia Nervosa/complications/*diagnosis
Emphysema/complications/*diagnosis
Female
Gastric Dilatation/complications/*diagnosis/radiography
Humans
Intubation, Gastrointestinal
Superior Mesenteric Artery Syndrome/diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 (A) Severe gastric gaseous distention was noted on plain abdominal radiograph. (B) Consequently, abdominal left hemidiaphragmatic elevation was visualized on plain chest radiograph.

• 

  Fig. 2 Contrast media enhanced abdominal computed tomography. (A) Multiple air (white arrows) densities were seen in the distended gastric wall. (B) Coronal image showed multiple air (white arrow) densities in the gastri wall. The second portion of the duodenum was dilated (white blank arrow). (C) Severe narrowing the space (white arrow head) between the aorta and superior mesenteric artery and markedly dilated second portion (white blank arrow) were also seen. Nasogastric tube was inserted to decompress the distended stomach.

• 

  Fig. 3 Upper gastrointestinal series. The contrast material-filled duodenal lumen (white arrow) showed abrupt vertical cut-off (white blank arrow) in front of the lumbar vertebrae due to superior mesenteric artery syndrome.

• 

  Fig. 4 Upper gastrointestinal series on the hospital 27 days after nasogastric tube removal showed no delayed passage of barium on the third portion of the duodenum.

Reference

1. Rosen A, Ariely D, Sorin E, Czerniak A. Emphysema of the stomach: a roentgenologic alarm. Report of a case and review of the literature. J Clin Gastroenterol. 1996. 23:211–213.

2. Reimunde E, Gutiérrez M, Balboa O, Espinel J, Rodríguez C. Gastric pneumatosis. Gastroenterol Hepatol. 2002. 25:458–461.

3. Low VH, Thompson RI. Gastric emphysema due to necrosis from massive gastric distention. Clin Imaging. 1995. 19:34–36.

4. Loi TH, See JY, Diddapur RK, Issac JR. Emphysematous gastritis: a case report and a review of literature. Ann Acad Med Singapore. 2007. 36:72–73.

5. Kussin SZ, Henry C, Navarro C, Stenson W, Clain DJ. Gas within the wall of the stomach report of a case and review of the literature. Dig Dis Sci. 1982. 27:949–954.

6. Huang CT, Liao WY. Emphysematous gastritis: a deadly infectious disease. Scand J Infect Dis. 2009. 41:317–319.

7. Ocepek A, Skok P, Virag M, Kamenik B, Horvat M. Emphysematous gastritis -- case report and review of the literature. Z Gastroenterol. 2004. 42:735–738.

8. Yalamanchili M, Cady W. Emphysematous gastritis in a hemodialysis patient. South Med J. 2003. 96:84–88.

9. Allan K, Barriga J, Afshani M, Davila R, Tombazzi C. Emphysematous gastritis. Am J Med Sci. 2005. 329:205–207.

10. Al-Jundi W, Shebl A. Emphysematous gastritis: case report and literature review. Int J Surg. 2008. 6:e63–e66.

11. Shipman PJ, Drury P. Emphysematous gastritis: case report and literature review. Australas Radiol. 2001. 45:64–66.

12. Hadley SJ, Walsh BT. Gastrointestinal disturbances in anorexia nervosa and bulimia nervosa. Curr Drug Targets CNS Neurol Disord. 2003. 2:1–9.

13. Benini L, Todesco T, Dalle Grave R, Deiorio F, Salandini L, Vantini I. Gastric emptying in patients with restricting and binge/purging subtypes of anorexia nervosa. Am J Gastroenterol. 2004. 99:1448–1454.

14. Pentlow BD, Dent RG. Acute vascular compression of the duodenum in anorexia nervosa. Br J Surg. 1981. 68:665–666.

15. Franken EA Jr, Fox M, Smith JA, Smith WL. Acute gastric dilatation in neglected children. AJR Am J Roentgenol. 1978. 130:297–299.

16. Yokoi Y, Hirayama K. Gastric emphysema, a critical condition accompanied by eating disorders: a case report. Nihon Shokakibyo Gakkai Zasshi. 2010. 107:1635–1640.

17. Lee YH, Park CH, Park CJ, Pai ST. A case of the superior mesenteric artery syndrome. Korean J Gastroenterol. 1992. 24:171–176.