Karanicolas, Paul J.

Lim, Rodrick K.

McKillop, Scott

Scott, Leslie

English

Scholarship@Western

Western University Scholarship@Western Paediatrics Publications Paediatrics Department 3-23-2010 Massive gastric pneumatosis from pyloric stenosis Rodrick K. Lim Schulich School of Medicine & Dentistry, rod.lim@lhsc.on.ca Scott McKillop Schulich School of Medicine & Dentistry Paul J. Karanicolas Schulich School of Medicine & Dentistry Leslie Scott Schulich School of Medicine & Dentistry, leslie.scott@lhsc.on.ca Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Lim, Rodrick K.; McKillop, Scott; Karanicolas, Paul J.; and Scott, Leslie, "Massive gastric pneumatosis from pyloric stenosis" (2010). Paediatrics Publications. 2172. https://ir.lib.uwo.ca/paedpub/2172 PracticeCMAJCMAJ • MARCH 23, 2010 • 182(5)© 2010 Canadian Medical Association or its licensorsE227A12-week-old infant presented with a one-day historyof increased vomiting and lethargy. Gastro -esophageal reflux had been diagnosed when he wasfour weeks old, but the symptoms had not lessened, despite achange of formula. The infant was severely dehydrated andhad gastric distension, a decreased level of consciousnessand gasping respirations. There was no abdominal tender-ness. He was resuscitated with tracheal intubation and intra-venous fluids. A plain radiograph  showed massive gastricpneumatosis (Figure 1). Blood test results showedhypochloremic metabolic alkalosis. Ultrasonography sug-gested hypertrophic pyloric stenosis. The patient was stabi-lized, and a nasogastric tube was inserted for decompression.At the time of pyloromyotomy five days after admission, hehad a markedly hypertrophied pylorus, and  pneumatosis wasstill palpable in the stomach wall. The infant was dischargedhome in good condition four days after surgery.Fraenkel first described the unusual presentation of airwithin the wall of the stomach in 1889.1 The condition can benoninfectious (gastric pneumatosis) or infectious (emphyse-matous gastritis). The mortality rate for gastric pneumatosis is41% in adults and 6% in children.2Gastric pneumatosis is caused by a disruption of the gas-tric mucosa, which results in air dissecting into the stomachwall. This disruption typically results from gastric outletobstruction caused by pyloric stenosis (as in this case), duode-nal stenosis3 or tumours; it can also result from protractedvomiting, instrumentation or tracking of air through the medi-astinum or the pneumothorax. Pyloric stenosis is the mostcommon cause of intestinal obstruction in infants.Emphysematous gastritis refers to mucosal disruptioncaused by gas-forming bacterial invasion. An antecedent gas-tric mucosal injury may allow infiltration of the bacteria.Causes in infants include necrotizing enterocolitis, causticingestion, recent abdominal surgery or gastroenteritis.4 Thesepatients present with fever, appear unwell and have laboratoryevidence of leukocytosis.This article has been peer reviewed.Competing interests: None declared.REFERENCE1. Fraenkel E. Uber einen fall von gastritis acuta emphysematosa wahrscheinlichmykotischen ursprungs. Virchows Arch Pathol Anat 1889:118;526-35.2. Taylor D, Tung J, Baffa J, et al. Gastric pneumatosis: a case report and review ofthe literature. Int Pediatr 2000;15:117–20.3. D’Cruz R, Emile S. Gastroduodenal emphysema. J Pediatr Surg 2008;43:2121–3.4. Moosvi AR, Saravolatz LD, Wong HD, et al. Emphysematous gastritis: case reportand review. Rev Infect Dis 1990;12:848–55.Clinical imagesMassive gastric pneumatosis from pyloric stenosisRodrick K. Lim BSc MD, Scott McKillop MD, Paul J. Karanicolas MD PhD, Leslie Scott MDFrom the Department of Pediatrics (Lim, McKillop, Scott), the Departmentof Radiology (McKillop) and the Department of Surgery (Karanicolas, Scott),Children’s Hospital, London Health Sciences Centre, Schulich School of Med-icine & Dentistry, University of Western Ontario, London, Ont.CMAJ 2010. DOI:10.1503/cmaj.090200DOI:10.1503/cmaj.090200Figure 1: A plain radiograph of the abdomen of a 12-week-oldinfant showing massive gastric pneumatosis within walls ofstomach (arrows).Previously published at www.cmaj.ca

Massive gastric pneumatosis from pyloric stenosis

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Massive gastric pneumatosis from pyloric stenosis

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