Is surgical intervention avoidable in cases of emphysematous gastritis? A case presentation and literature review

AbstractINTRODUCTIONGas located within the gastric wall is a rare finding that is associated with a mortality rate of 50%. It confers two main diagnoses: gastric emphysema and emphysematous gastritis. Due to its high mortality rate, emphysematous gastritis must be differentiated from gastric emphysema early to avoid adverse outcomes and plan the management of these patients.PRESENTATION OF CASEWe introduce a 55 year-old male who presents with diffuse abdominal pain associated with fever, nausea, vomiting, and diarrhea. Patient has positive peritoneal signs with fever and leukocytosis. Air in the gastric wall and portal venous system was visualized on Computed Tomography (CT). The patient underwent emergent laparotomy which showed normal bowel with few adhesions.DISCUSSIONVarious etiologies can cause gas within the gastric wall but concomitant air in the hepatic venous system is highly suspicious for emphysematous gastritis. CT imaging is the most sensitive and specific way to differentiate emphysematous gastritis versus gastric emphysema. Although rare, there are many cases of emphysematous gastritis that undergo prompt surgical exploration. Recently, however, medical treatment has become more common and surgical management reserved for complications.CONCLUSIONWe conclude by stating that this case of emphysematous gastritis, due to gastric ulcers, would have no difference in outcome if treated medically instead of surgically. Historically, patients with emphysematous gastritis warranted surgical intervention. More recently, case reports of emphysematous gastritis are favoring conservative management. The consensus still remains that there is no standard approach for these patients and most patients in extremis are undergoing surgical intervention

Venous Adventitial Cystic Disease: A Review of 45 Cases Treated Since 1963

Purpose. To review and identify the most accurate ways of diagnosing and treating adventitial cystic disease (ACD) of the venous system. Methods. Cases of ACD were collected through three popular medical databases, including PubMed, Cochrane, OVID, and MEDLINE. After reviewing the literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and all cases of arterial ACD were excluded. The clinical features, treatment, and subsequent course of 45 cases of venous ACD are included in this paper. Results. After reviewing all 45 cases of venous ACD , we have confirmed that the most common vessel affected is the common femoral vein, which reproduces the most common symptom of venous ACD: asymmetric lower extremity swelling worsening over time. Conclusion. Venous ACD most commonly affects the common femoral vein. When unilateral leg swelling occurs with or without a noticeable mass, ACD should be considered. It is best confirmed with CT venography and the treatment of choice is transluminal cyst evacuation and excision