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Emphysematous gastritis with hepatic portal venous gas: a shift towards conservative management
  1. Fredy Nehme,
  2. Kyle Rowe,
  3. Imad Nassif
  1. Department of Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
  1. Correspondence to Dr Fredy Nehme, nehme.fredy{at}

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A female aged 94 years with a history of diabetes presented with acute onset abdominal pain, haematemesis and altered mental status. She denied alcoholism, corrosive ingestion, pancreatitis or abdominal trauma. She appeared toxic and was hypotensive. Her hemogram showed leucocytosis at 14.8 x 10^9/L. CT scan of the abdomen showed air scattered within the liver, portal vein and gastric wall (figures 1 and 2). Also, dense calcifications of the aorta and abdominal arteries were noted (figure 3). Due to the high risk of surgery, she was managed conservatively with proton pump …

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