A Case of Gastric Emphysema with Intra-abdominal Free Gas and Mediastinal Emphysema that Resolved with Conservative Treatment

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  • SAITO Tomoya
    Department of Surgery, National Hospital Organization Hokkaido Medical Center
  • KAWAMURA Hideki
    Department of Surgery, National Hospital Organization Hokkaido Medical Center
  • YOSHIDA Takuto
    Department of Surgery, National Hospital Organization Hokkaido Medical Center
  • KONISHI Yuji
    Department of Surgery, National Hospital Organization Hokkaido Medical Center
  • MINO Kazuhiro
    Department of Surgery, National Hospital Organization Hokkaido Medical Center

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Other Title
  • 保存的加療で軽快した腹腔内遊離ガス・縦隔気腫を伴う胃気腫症の1例
  • ホゾンテキ カリョウ デ ケイカイ シタ フクコウ ナイ ユウリ ガス ・ ジュウカクキシュ オ トモナウ イキシュショウ ノ 1レイ

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Abstract

<p>The patient was a 64-year-old woman. For these several years she was on post-tracheostomy and gastrostomy nutrition due to multiple system atrophy. Two days before coming to our hospital, enteral tube feeding fluid flew out through her tracheostomy orifice after nutritional administration. She had fever and was admitted to our hospital with a suspected diagnosis of pneumonia. A CT scan showed intragastric emphysema and intra-abdominal free gas and mediastinal emphysema. She was conservatively treated because abdominal symptoms and findings suggestive of ischemia were absent. Seven days later, a CT scan showed that the findings had disappeared, and 9 days later, upper gastrointestinal endoscopy confirmed that there were no ischemic changes in the mucosa. Her nutrient administration was resumed. Seven days after the resumption, flowing out of the nutrient from the tracheostomy orifice flared up again, and a CT scan showed intramural emphysema and portal venous gas, but the patient again recovered with conservative treatment. Most cases of gastric emphysema have a good prognosis with conservative treatment. Intra-abdominal free gas, portal gas, and mediastinal emphysema are findings suggestive of gastrointestinal perforation or intestinal ischemia, but surgery may be avoided if no abdominal symptoms are present. It is important to make a judgment based not only on imaging findings but also on the patient's general condition and physical examination.</p>

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