Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.
Aged, 80 and over ; Emphysema/complications/*diagnosis/drug therapy ; Female ; Gastritis/complications/*diagnosis/drug therapy ; Gastroscopy ; Humans ; Portal Vein ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.
Anti-Bacterial Agents/therapeutic use ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Gastroscopy ; Hematemesis/complications/diagnosis ; Humans ; Male ; Mediastinal Emphysema/complications/*diagnosis/drug therapy ; Middle Aged ; Tomography, X-Ray Computed

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.
Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Bile Duct Neoplasms/complications/diagnosis ; Bile Ducts, Intrahepatic/pathology ; Cefotaxime/therapeutic use ; *Cholangiocarcinoma/complications/diagnosis ; Clostridium Infections/drug therapy/microbiology ; Clostridium perfringens/isolation & purification ; Emphysema/complications/*diagnosis ; Escherichia coli/isolation & purification ; Escherichia coli Infections/drug therapy/microbiology ; Female ; Hepatitis/complications/*diagnosis ; Humans ; Metronidazole/therapeutic use ; *Pneumoperitoneum/complications/diagnosis ; Tomography, X-Ray Computed

Emphysematous prostatic abscess is a very rare form of prostatitis. Emphysematous prostatic abscess due to Klebsiella pneumoniae may have a poor prognosis according to a few previous reports. We report a rare case of successfully treated emphysematous prostatic abscess with cystitis due to Klebsiella pneumoniae in a 50-yr-old man with 15-yr history of diabetes mellitus. The patient was referred to the emergency room of our hospital. The KUB film revealed gas shadows in the lower pelvic area suggestive of emphysematous cystitis or emphysematous prostatic abscess. The gas was mainly occupying the prostate and was also seen in the bladder on pelvic CT. The patient was successfully treated with long-term antibiotic use and additional percutaneous drainage of the abscess. Emphysematous prostatic abscess may be misdiagnosed as emphysematous cystitis due to the similar location of gas shadows on radiography. Computerized tomography and transrectal ultrasonography are helpful in making the diagnosis of emphysematous prostatic abscess. Appropriate use of effective antibiotics with drainage of pus is the best treatment. This case emphasizes the importance of timely and accurate diagnosis followed by appropriate treatment in emphysematous prostatic abscess in diabetic patients.
Abscess ; Anti-Bacterial Agents/therapeutic use ; Cystitis/diagnosis ; Diabetes Mellitus/complications ; Drainage ; Emphysema/diagnosis/*microbiology ; Human ; Klebsiella Infections/*diagnosis/drug therapy ; Klebsiella pneumoniae/*metabolism ; Male ; Middle Aged ; Prostate/*microbiology ; Prostatic Diseases/*diagnosis/microbiology/radiography

Smoking is associated with poor symptom control and impaired therapeutic responses in asthma. A total of 843 patients with asthma were recruited. The patients received treatment for 1 yr according to the severity of their asthma. We compared the forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 to forced vital capaity (FVC), atopy, total IgE, emphysema on high-resolution computed tomography (HRCT), the number of near-fatal asthma attacks, and physiological fixed airway obstruction between the smoking and nonsmoking groups. The study population consisted of 159 (18.8%) current smokers, 157 (18.7%) ex-smokers, and 525 (62.5%) nonsmokers. Although the prevalence of atopy was not different between the smoking and nonsmoking groups, the total IgE was higher among the smokers than the nonsmokers. Compared with the nonsmoking group, the smokers had a lower FEV1 % predicted and forced expiratory flow between 25 and 75% of FVC. A greater prevalence of emphysema and a significantly higher number of asthmatic patients with fixed airway obstruction were detected in the smoking versus nonsmoking group. The 37.5% of asthmatic patients who were former or current smokers showed decreased pulmonary function and increased IgE, emphysema on HRCT, and fixed airway obstruction, indicating that smoking can modulate the clinical and therapeutic responses in asthma.
Airway Obstruction/etiology ; Asthma/complications/*diagnosis/*drug therapy ; Female ; Forced Expiratory Volume/physiology ; Humans ; Immunoglobulin E/analysis ; Male ; Middle Aged ; Pulmonary Emphysema/etiology/radiography ; Respiratory Function Tests ; Respiratory Insufficiency/etiology ; Smoking/*adverse effects ; Tomography, X-Ray Computed