Ewha Med J.  2014 Sep;37(2):141-145. 10.12771/emj.2014.37.2.141.

Gastric Emphysema Related with Superior Mesenteric Artery Syndrome

• Lee YM
• Song HJ
• Na SY
• Boo SJ
• Kim HU
• Kim SH

• KMID: 2171299
• DOI: http://doi.org/10.12771/emj.2014.37.2.141

Abstract

Gastric emphysema is caused by a mucosal disruption of stomach, which is leading to the dissection of air into the wall. A 24-year-old man admitted to our hospital with vomiting, abdominal distension, and pain. Abdominal computed tomography showed severe gastric distension, air within the gastric wall, and a compressed third segment of the duodenum by superior mesenteric artery (SMA). The upper endoscopy revealed multiple geographic ulcers in the gastric body and marked dilatation of the second segment of duodenum and a collapsed third segment. Based on these findings and his symptoms, the patient was diagnosed as having gastric emphysema related with SMA syndrome. He improved after the nasogastric decompression, jejunal feeding and administration of antibiotics. We report a rare case of gastric emphysema related with SMA syndrome. He was managed successfully with medical treatment and nutritional support.

Keyword

Gastric emphysema; Superior mesenteric artery syndrome; Gastric dilatation

MeSH Terms

Anti-Bacterial Agents
Decompression
Dilatation
Duodenum
Emphysema*
Endoscopy
Gastric Dilatation
Humans
Mesenteric Artery, Superior
Nutritional Support
Stomach
Superior Mesenteric Artery Syndrome*
Ulcer
Vomiting
Young Adult
Anti-Bacterial Agents

Figure

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  Fig. 1 Contrast enhanced abdominal computed tomography scan. It shows severe gastric distention with air-fluid level and fluid-filled duodenal dilatation. Extrinsic compression of third segment of duodenum between superior mesenteric artery (SMA) and abdominal aorta and a narrow aortomesenteric angle to 12° (A, black arrows) are suggestive of SMA syndrome. Multiple thin linear air densities within the distended gastric wall is suggestive of gastric emphysema (B, white arrow).

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  Fig. 2 Upper endoscopy. It shows many geographic gastric ulcers with mucosal hemorrhage in the body of stomach (A, B), and collapsed third segment associated with the superior mesenteric artery syndrome (C).

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  Fig. 3 Nasojejunal feeding tube insertion with fluoroscopic guidance on the fourth day of hospital. Extrinsic compression of third segment of duodenum is compatible with superior mesenteric artery syndrome (black arrow).

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  Fig. 4 Follow-up upper endoscopy after 2 months showed complete recovery from the gastric emphysema (A, B) and a mildly constricted third segment of the duodenum by extrinsic superior mesenteric artery compression (C).

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