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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 454

Abdominal computed tomography revealed gastric pneumatosis with pneumoperitoneum and complete thrombosis of the coeliac trunk. Upper endoscopy showed necrosis of the lesser curvature reaching the duodenum, diffuse erythema and swelling of the remaining gastric mucosa, and a prepyloric 1 cm wide gastric ulcer. Purulent sterile liquid surrounded the stomach at laparotomy. The great tuberosity of the stomach was necrotic with diffuse surface necrosis of the remaining stomach and the right and sigmoid colon. The small intestine was also ischaemic with diffuse petechiae on its surface. Extended thrombosis of the left femoral artery precluded clearing of the obstruction with a Fogarty catheter. At this point, no procedure was deemed possible and the patient died 12 hours later.

Gastric pneumatosis is not a disease but a finding that should be investigated based on the patient’s clinical situation, and on his past and presenting history. These situations include: (1) gastric emphysema (gastric outlet syndrome, gastric carcinoma, intestinal volvulus, small bowel obstruction, forceful vomiting, and gall stones); (2) emphysematous gastritis (Escherichia coli, Enterobacter, Clostridium species, Pseudomonas aeruginosa, Bacillus species, Aerobacter aerogenes, Staphylococcus aureus, caustic or corrosive substances, alcohol intoxication, ischaemia, infarction, previous gastrointestinal surgery, strongyloidosis, diabetes, and immunosuppression); and (3) pneumatosis cystoides intestinalis (neoplastic, infectious, chemicals, and mechanical).

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