Emphysematous Gastritis is a Severe Infectious Disease

Purpose Emphysematous gastritis (EG) is a rare form of infectious gastritis reported in many immunocompromised patient with extreme severity and many potential comorbidities. However, despite lots of critically ill case reports, there is a trend towards conservative management. Furthermore, it has never been described in refractory septic intensive care unit patient treated successfully with a sleeve gastrectomy. We wanted to focus on the progress made in diagnosis and treatments since the early 2000s and to report a case. Methods We report the case of a critically ill and immunocompromised 45-year-old women, who presented an EG secondary to an ileus due to a high dose of barbiturates for a refractory epilepticus status. Then, we conducted a literature search for reported adult cases of EG since 2000. Results Study cohort included 53 new cases of EG since 2000. Mean age was 54, and mean (SD) length of stay was 23 ± 36 days. Diabetes mellitus is still the main predisposing factor identified. Causative pathogen was found in only 40% of the cases, mostly Enterobacteriaceae, Enterococcus spp, and Streptococcus. An emergent surgery was required in only 6 cases of refractory septic shock or gastric necrosis. The global mortality rate reached 34%. Conclusions Emphysematous gastritis remains a severe disease, which can evolve quickly in septic shock or in gastric necrosis. Early diagnosis and management are warranted to favor a conservative management, even for severe forms and prevent further complications. Cases refractory to supportive measures can be successfully managed with minimally invasive surgery.