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Gastric pneumatosis/interstitial emphysema of the stomach

Article in Archives of Disease in Childhood - Fetal and Neonatal Edition · April 2004
DOI: 10.1136/fn.89.2.F188 · Source: PubMed

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Manan Bajaj Amanda L Ogilvy-Stuart

University of Western Australia Cambridge University Hospitals NHS Foundation Trust
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 F188 Arch Dis Child Fetal Neonatal Ed 2004;89:F188

IMAGES IN NEONATAL MEDICINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastric pneumatosis/interstitial emphysema of the stomach

T
his entity was first described in 1889 by
Fraenkel in adults.1 It is rare and
primarily a radiological diagnosis. It
has been seen in preterm and term babies,
and infants up to 9 months of age. In adults,
infection with gas forming organisms
(Escherichia coli, Proteus, Clostridium welchii,
and Staphylococcus aureus), gastric outlet
obstruction, and instrumentation are the
more commonly reported associations. In
newborn babies, it is usually associated with
widespread necrotising enterocolitis.
We came across this radiological finding in
a 32 week gestation baby who became
acutely unwell on day 4. Enteral feeds had
been started on day 2. Abdominal radio-
graphs also showed widespread pneumatosis
intestinalis (fig 1). Blood cultures were
negative, but umbilical and ear swabs grew
E coli.
This radiological sign may indicate other
conditions that require urgent surgical man-
agement, such as hypertrophic pyloric ste-
nosis2 or duodenal stenosis.3 In these cases it
has been suggested that gas enters the
intramural space through mucosal tears
produced from overdistention of the sto-
mach. Gastric decompression usually leads
to rapid clearance (16–20 hours) of this
radiological finding2 and good recovery after
appropriate surgical management. At opera-
tion on day 10 in our patient, there were
multiple areas of small intestinal necrosis,
but the stomach looked normal. Gastric
pneumatosis has also been reported second-
ary to intramural malplacement of a feeding
catheter4 and after cardiac surgery in the
newborn period.5 The proposed cause in the
latter scenario is temporary hypoperfusion of
the gastrointestinal mucosa during cardio-
pulmonary bypass and ischaemic injury to
the stomach causing mucosal disruption.

M Bajaj, A L Ogilvy-Stuart
Rosie Hospital, Addenbrooke’s NHS Trust,
Cambridge CB2 2QQ, UK; monikabajaj29@
hotmail.com

doi: 10.1136/adc.2003.034272

REFERENCES
1 Henry GW. Emphysematous gastritis. AJR
Am J Roentgenol 1952;68:15–18. Figure 1 Abdominal radiograph showing gastric pneumatosis.
2 Lester PD, Budge AF, Barnes JC, et al. Gastric
emphysema in infants with hypertrophic pyloric
stenosis. AJR Am J Roentgenol 1978;131:421–3.
3 Gupta A. Interstitial gastric emphysema in a child
with duodenal stenosis. Br J Radiol
1977;50:222–4.
4 Mandell GA, Finkelstein M. Gastric pneumatosis
secondary to an intramural feeding catheter.
Pediatr Radiol 1988;18:418–20.
5 Taylor DR, Tung JY, Baffa JM, et al. Gastric
pneumatosis following cardiac surgery.
Eur J Paediatr 2000;159:553–4.

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