The appearance of gas within the wall of the stomach is an extremely rare occurrence and can be infectious or noninfectious in origin (1). We report a patient with gastric pneumatosis of unknown origin who was managed nonoperatively.

Case Report

A 56-year-old male presented to the emergency department with acute upper abdominal pain without vomiting. On admission, he had epigastric tenderness without fever. Pancreatic function tests (i.e., lipase and amylase) were normal. Abdominal and plain chest X-rays did not show either free gas under the diaphragm nor gastric pneumatosis. Abdominal CT scan, with oral and intravenous contrast demonstrated multiple foci of gas within the gastric wall along the greater curvature (Figure 1), with associated gas in the portal venous system (Figure 2). There was neither pneumoperitoneum nor free peritoneal fluid, and the mesenteric vessels were patent. The patient was admitted for fluid resuscitation, bowel rest with nasogastric (NG) tube decompression, and serial abdominal exams. The patient’s condition improved safely without surgery. Some other exams were performed such as an upper gastrointestinal endoscopy and a colonoscopy which were normal. After a follow-up of 18 months, the patient remains healthy.

Figure 1 : Abdominal CT scan showed a gastric pneumatosis.



Figure 2 : Abdominal CT scan showed a portal venous gas.



Conclusion

The finding of gastric pneumatosis associated to an aeroportia and their resolution with non-operative management make our case interesting. Traditional surgical dogmas have dictated that patients with pneumatosis should undergo exploration. We believe that conservative supportive care may be a safe approach in the management of non-gangrenous gastric pneumatosis associated to an aeroportia.