Intramural Gastric Emphysema

Abstract

Gastric emphysema is characterised by air dissection within the wall of the stomach. The few cases which have been reported in the literature occurred following gastroscopy, emphysematous gastritis and pneumatosis cystoides intestinalis. The present communication deals with a case of intramural gastric emphysema which developed following over-distension of the stomach due to obstruction of the duodenum by an impacted gall-stone. Review of the literature has failed to disclose such an occurrence. A 75-year-old female was admitted to the emergency ward because of severe intractable vomiting for three days. The past history revealed that the patient had some minor “indigestion”. Three weeks prior to her admission an X-ray examination of the stomach and duodenal bulb had not revealed any pathology. The stomach was normal in size and shape. On admission the patient was dehydrated but not undernourished. The abdomen was not markedly distended, no resistance was palpated, no signs of any peritoneal irritation were detected. Plain radiographs of the abdomen, supine, upright and lateral positions (Figs. 1a, 1b and 1c) demonstrated a continuous radiolucent frame outlining the stomach. The air lines were constant, fixed and did not shift freely or change shape with the change of position of the patient. The thin air lines were in different tissue planes, probably in the submucosa and subserosa enclosed within the gastric wall.