Emphysematous Gastritis with Concomitant Portal Venous Air and Acute Necrotizing Esophagitis in Type 1 Diabetes with Diabetic Ketoacidosis: A Case Report and Literature Review of a Rare Complication in Diabetes.

Oh,  Hyunwoo; Lee,  Hyoyoung; Chang,  Ki Sul; Park,  Jung Hwan; Hong,  Sang Mo; Lee,  Hang Lak; Lee,  Chang Bum; Park,  Yongsoo; Kim,  Dongsun; Choi,  Woong Hwan; Chung,  Won Sang; Ahn,  You Hern

doi:2016.17.2.139

J Korean Diabetes > Volume 17(2); 2016 > Article

Case Report

The Journal of Korean Diabetes 2016;17(2):139-145.
DOI: https://doi.org/10.4093/jkd.2016.17.2.139 Published online July 8, 2016.

당뇨병성 케톤산증이 발생한 제1형 당뇨병 환자에서 병발한 간문맥 내 공기를 동반한 기종성 위염과 급성괴사성 식도염

박정환, 안유헌, 정원상, 최웅환, 이창범, 이항락, 홍상모, 장기설, 오현우, 이효영, 박용수, 김동선

Emphysematous Gastritis with Concomitant Portal Venous Air and Acute Necrotizing Esophagitis in Type 1 Diabetes with Diabetic Ketoacidosis: A Case Report and Literature Review of a Rare Complication in Diabetes.

Hyunwoo Oh, Hyoyoung Lee, Ki Sul Chang, Jung Hwan Park, Sang Mo Hong, Hang Lak Lee, Chang Bum Lee, Yongsoo Park, Dongsun Kim, Woong Hwan Choi, Won Sang Chung, You Hern Ahn

¹Division of Endocrinology, Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea. ahnyh@hanyang.ac.kr
²Division of Endocrinology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
³Division of Gastroenterology, Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
⁴Department of Thoracic and Cardiovascular Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.

Abstract

Emphysematous gastritis is a rare disorder characterized by emphysematous change of the gastric wall due to infection with a gas-forming organism. Acute necrotizing esophagitis is a rare disorder with an unknown pathogenesis. Above two disorders rarely occur together, only three global cases have been reported to date. Such a case has never been reported in Korea, we report a novel case of severe emphysematous gastritis with concomitant portal venous air and acute necrotizing esophagitis in type 1 diabetes presenting with diabetic ketoacidosis. A 24-year-old man known to have type 1 diabetes and pulmonary tuberculosis was brought to the emergency room for epigastric pain with vomiting. His body mass index was 14.7, and the laboratory findings demonstrated leukocytosis and acidosis, as well as elevated serum glucose, ketone, and C-reactive protein levels. Enhanced computed tomography showed portal vein gas and edematous wall thickening without enhancement in the stomach wall, with air density along the stomach and esophageal wall. The patient required surgical intervention of total gastrectomy and cervical esophagostomy followed by esophagocolostomy and esophageal reconstruction. Early radiologic diagnosis and clinical suspicion of this disease and prompt intervention including antibiotics, decompression, and surgery are important for a good prognosis.

Key Words: Acute necrotizing esophagitis, Diabetic ketoacidosis, Emphysematous gastritis