Conservative management of emphysematous esophagitis-a case report

Background: Emphysematous esophagitis is a very rare disease and there are only a few previous reports in the literature. Previously reported cases have resulted in emphysematous esophagitis following anterior cervical procedures or ingestion of hydrogen peroxide (HP). In this report, we describe a case in which a patient with emphysematous esophagitis accompanied by gastritis without the above predisposing factors was treated with conservative treatment.

Case description: A 65-year-old woman was admitted to Inje University Sanggye Paik Hospital with general weakness, abdominal discomfort, nausea and chest discomfort. On chest and abdominal radiographs, there were abnormal air density in upper mediastinum and abdomen. Chest and abdomen computed tomography (CT) revealed mural air at entire esophagus and stomach. The patient managed with proton pump inhibitor (PPI), broad spectrum antibiotic therapy, and total parenteral nutrition (TPN).

Conclusions: Emphysematous gastritis occurs mainly along with emphysematous gastritis, with a mortality rate of up to 62%. It is mainly known to be caused by infection of the esophageal wall by gas forming bacteria, but there are also cases where there is no ingestion or exact cause. There is still controversy about treatment methods due to the high death rate, but if detected early like the reported patient, a good outcome can be expected with conservative treatment alone.