What happened, in summary

A 92-year-old woman with gastric adenocarcinoma, hypertension, and severe dementia came to the emergency department after several days of diffuse abdominal pain, nausea, and vomiting. Her family reported no vomiting of blood or rectal bleeding. She was stable and had generalized abdominal tenderness without signs of a rigid abdomen. Imaging supported a diagnosis of emphysematous gastritis, a severe infection in which gas forms within the stomach wall.

Treatment began with intravenous fluids, meropenem, and esomeprazole. Blood cultures remained negative. She improved clinically after 1 week and completed 17 days of meropenem. A CT scan 2 weeks after presentation showed that the gas in the stomach wall had resolved.

Severe gastric stasis prevented oral feeding, so she received total parenteral nutrition. Attempts to feed through a tube or place a pyloric stent were unsuccessful because the cancer continued to impair stomach emptying. Given her age, severe dementia, and cancer, the team chose conservative management and referred her for palliative care. She later developed acute pancreatitis, considered possibly related to lipid-rich parenteral nutrition, and died.