Emphysematous gastritis in a patient with coxsackie B3 myocarditis and cardiogenic shock requiring veno-arterial extra-corporeal membrane oxygenation

• Emphysematous gastritis is a rare, potentially fatal condition with a mortality rate of 55–61%.
• Predisposing factors include: immunosuppression, malignancy, alcohol, medication abuse (especially non-steroidal anti-inflammatory drugs), post abdominal/pelvic surgery and corrosive ingestion.
• Management of emphysematous gastritis usually revolves around supportive care, broad spectrum antibiotics and bowel rest.
• Mortality as a result of surgical intervention is as high as 21%.

IntroductionEmphysematous gastritis is a rare condition in which gas accumulates in the stomach lining usually due to an infectious source.Case presentationWe present a 16 year old female with viral myocarditis and cardiogenic shock transferred to our hospital on extracorporeal membrane oxygenation (ECMO) who developed emphysematous gastritis. After listing the patient for heart transplant, patient underwent Bi-VAD placement requiring veno-venous ECMO support. Subsequently, she developed worsening abdominal distention. CT of abdomen/pelvis showed the stomach to be diffusely edematous, thick-walled, containing intramural gas collections, consistent with emphysematous gastritis. Patient underwent nonoperative management and two weeks later had complete resolution of the gastritis. Unfortunately, her overall condition deteriorated in the subsequent days and support was withdrawn.DiscussionManagement of emphysematous gastritis usually revolves around supportive care, broad spectrum antibiotics and bowel rest. Our patients’ gastritis resolved with non-operative management, albeit, she succumbed to multiorgan failure due to other causes.ConclusionWe believe, this is a unique case of a veno-arterial ECMO causing emphysematous gastritis.