Korean J Gastroenterol.  2015 Feb;65(2):118-122. 10.4166/kjg.2015.65.2.118.

Emphysematous Gastritis with Concomitant Portal Venous Air

  • 1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. jikim@catholic.ac.kr


Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.


Gastritis; Endoscopy; Computed tomography

MeSH Terms

Aged, 80 and over
Emphysema/complications/*diagnosis/drug therapy
Gastritis/complications/*diagnosis/drug therapy
Portal Vein
Proton Pump Inhibitors/therapeutic use
Tomography, X-Ray Computed
Proton Pump Inhibitors


  • Fig. 1. The air shadow and diffuse dilatation of esophageal and stomach wall are seen along with air (arrow) in the extra-hepatic and intrahepatic portal vein.

  • Fig. 2. Esophagitis combined with mucosal edema, redness, exudates, and erosions are observed. Gastritis combined with necrosis of mucosal epithelium is also observed from fundus to body.

  • Fig. 3. Follow-up endoscopy after 2 weeks shows overall improvement of esophagitis and gastritis combined with necrosis of mucosal epithelium from fundus to body.

  • Fig. 4. Follow-up endoscopy after 4 weeks shows more improved esophagitis and gastritis combined with necrosis of mucosal epithelium from fundus to body, and the area of inflammation has also decreased. Muscularis propria is exposed at the gastric ulcer base where necrotic mucosa has been detached.

  • Fig. 5. Resolution of previously observed esophageal, gastric and portal venous air indicates improvement of emphysematous gastritis.



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