Gastric pneumatosis and hepatoportal venous gas in superior mesenteric artery syndrome: a case report

Area of Science:

• Gastroenterology
• Vascular Surgery
• Radiology

Background:

• Gastric pneumatosis, a rare condition of air in the stomach wall, can manifest as gastric emphysema or emphysematous gastritis.
• Hepatic portal venous gas (HPVG) is associated with high mortality rates, often prompting surgical intervention debates.
• Superior mesenteric artery syndrome (SMAS) is an uncommon cause of these gastrointestinal issues.

Purpose of the Study:

• To present a rare case of gastric pneumatosis and HPVG.
• To explore the association with SMAS.
• To highlight the potential for conservative management and benign outcomes despite severe initial signs.

Main Methods:

• Case report of an 87-year-old female with abdominal pain and vomiting.
• Diagnostic investigations revealed gastric emphysema and HPVG attributed to SMAS.
• Conservative management was initiated, followed by surgery for SMAS.

Main Results:

• The patient presented with severe symptoms and concerning radiological findings.
• Despite initial indications for surgery, conservative treatment led to successful outcomes.
• Endoscopic imaging showed dramatic initial presentation and subsequent clinical improvement.

Conclusions:

• This case underscores the rare co-occurrence of gastric pneumatosis, HPVG, and SMAS.
• It demonstrates the clinical variability of SMAS and the potential for favorable outcomes with conservative approaches.
• Treatment decisions should integrate etiology, clinical presentation, and laboratory data, not solely relying on alarming imaging findings.