Air in the stomach wall: A case Stomach diseases presentation and summary of the literature
MARTIN S. LANDIS, B.S., D. 0. Detroit, Michigan
Air in the stomach wall is rare, but its ing electrolyte studies were within normal presence can be demonstrated limits. The child, who had been born pre- maturely, had been observed frequently since radiographically. Early recognition of birth and had exhibited signs of mongolism the radiologic sign of air in the stomach (Down s syndrome), inability to take solid wall is essential because of the high foods, and frequent attacks of pneumonia mortality associated with five of the attributed to aspiration of gastric contents six conditions in which this sign from vomiting.
appears. The literature is reviewed for Radiographic findings cases in which this sign is present. Chest films were taken on June 1, 1964, at the A case is reported which demonstrates termination of the patient s last previous stay the classic features of pneumatosis in the hospital (Fig. 1). They reveal evidence cystoides intestinalis on the basis of the of a persistent chronic bronchitis and inter- proposed criteria for classification of stitial pneumonitis. Chest and abdominal air in the stomach wall. Knowledge films were taken on June 9, 1964, the day of the patient s admittance to the hospital (Fig. of the mechanisms producing its 2). The chest again reveals evidence of radiologic signs is essential if the chronic bronchitis and pneumonitis. The ab- correct treatment is to be dominal film shows a marked distention of the initiated promptly. stomach with what appears to be a mass filling the stomach cavity outlined by an air density. This gives the appearance of a large bezoar. An abdominal film was taken 6 hours later on the same day (Fig. 3, left). Again Air in the stomach wall is a rare finding. Its there is evidence of what appears to be a large recognition radiographically can be lifesaving. mass outlined by air within the stomach. On The following is the report of a case observed June 10, 1964, an abdominal film (Fig. 3, at Grandview Hospital, Dayton, Ohio, in June right), was taken after aspiration of 200 ml. 1964. of fluid from the stomach. At this time it was again noted that there still appeared to be a Case report mass in the stomach outlined by air. It was Case history also felt that the stomach appeared to show A 21/2-year-old boy was admitted to Grand- considerable thickening of its walls, suggest- view Hospital on June 9, 1964, with the chief ing the possibility of a phlegmonous gastritis. complaint of frequent emesis during the past An upper gastrointestinal examination was 48 hours. His admitting temperature, which done on June 10, 1964 (Fig. 4). The barium was 102 F. rectally, spiked to 104 F. and re- within the stomach revealed an air density turned to normal the following day. On June paralleling the outline of the stomach. This 10, 1964, the stomach was aspirated and 200 air density was felt to lie between the mucosa ml. of a dark brown fluid were removed. Find- and the submucosal layers of the stomach ings of routine laboratory procedures includ- wall. It resulted in a complete outlining of the
738/90 stomach wall with air. No intraluminal filling defects were noted, nor were there any areas of displacement of the stomach to suggest extragastric mass lesions. The duodenum ap- peared to be somewhat redundant and large. The 2-hour delay film revealed a persistent dilatation of the duodenum with a consider- able amount of barium being retained in the stomach. However, there was some evidence of barium in the small intestine, but no un- usual appearance of air density was seen about the remaining portion of the gastro- intestinal tract. After this examination em- Fig. 1. Top, anteroposterior view of the chest; bottom, physematous gastritis was given as a tenta- right lateral view of the chest June 1, 1964, showing evidence of persistent chronic bronchitis and inter- tive diagnosis. stitial pneumonia bilaterally. On June 11, 1964, abdominal films (Fig. 5) were again taken and showed a considerable amount of the barium contrast retained with- previous day, although there is some persist- in the large dilated duodenal cap. Otherwise ence of thickening of the gastric wall and the barium was seen to pass through the large evidence of subserosal gas in the various seg- bowel with little or no change in the small- ments of the gastric wall. intestinal pattern. The amount of gas con- On June 12, 1964, an upper gastrointestinal tained within the stomach wall is believed examination (Fig. 6) was again performed, to be considerably less than that seen on the with the barium contrast being administered
Fig. 2. Left, posteroanterior view of the chest; center, right lateral view of the chest; and right, supine abdo- men, June 9, 1964, showing persistent chronic bronchitis and pneumonitis, and marked distention of the stomach with what appears to be a mass filling the stomach cavity outlined by an air density.