Emphysematous gastritis in a patient with metastatic cholangiocarcinoma: a case report

<p><strong>Background: </strong>Emphysematous gastritis is a rare, life-threatening infection of the stomach wall caused by gas-forming bacteria. Fewer than 200 cases have been reported. The mortality rate has declined from 60% to 33% owing to earlier diagnosis and improved care. This report presents a case of emphysematous gastritis, highlighting the challenges with diagnosis and management.<br /><strong>Case presentation: </strong>A 70-year-old woman with unresectable cholangiocarcinoma and hepatic metastases presented with fever, abdominal pain, and coffee-ground vomiting. Imaging revealed gas within the gastric wall consistent with emphysematous gastritis. She was managed conservatively with intravenous antibiotics, fluids, and proton-pump inhibitors. Despite treatment, her condition worsened and she was transitioned to palliative care. She died on hospital day 21.<br /><strong>Conclusion: </strong>This case describes the difficulties in managing emphysematous gastritis in a patient with a complex medical history and advanced malignancy and the unfavorable outcome despite timely and appropriate treatment. It highlights the need for early recognition of emphysematous gastritis using imaging, aggressive medical therapy, and management by a multidisciplinary team.</p>