Gastric micropneumatosis: endoscopic and histologic findings/case report/

Gastric micropneumatosis is a rare disorder caused by accumulation of air bubbles within the gastric mucous membrane. The etiology is controversial, it may be caused by gas-forming organisms or more frequently by non-infectious factors. Predisposing factors include ingestion of caustic or corrosive substances, alcohol intoxication, most cases are associated with trauma, prior gastroscopy, gastric outlet or small bowel obstruction, rupture of pulmonary bullae, or portomesenterical ischaemia.

A 69 years old patient taking clopidogrel with the history of general arteriosclerosis and cerebral infarct was admitted to our department because of melaena and hematemesis. Physical examination revealed abdominal bruit above the umbilicus. Peptic esophagitis, friable, inflammed gastric mucosa covered with cattered pointwise bleeding was found by upper endoscopy and a raised map-like, pale intramucosal lesion surrounded by atrophic mucosa on the backwall of the corpus. Microscopic examination in the initial gastric biopsies revealed multiple empty spaces among corpus glands with no epithelial lining, 10–20µm in diameter and moderate inflammatory cell invasion. Helicobacter pylori positivity was also detected. Based on histological findings our diagnose was gastric micropneumatosis also known as pseudolypomatosis. Patient was treated with etamsylate, pantoprazol metoclopramide, pentoxiphylline and fluid supplementation intravenously. Endoscopy was repeated after 7 days. Examination showed no bleeding and regression of inflammation. In the histological samples empty spaces were no more detected. On the basis of the medical literature, patient's history and clinical findings we supposed mesenterical ischaemia and vomiting as possible etiological factors.

Gastric micropneumatosis is an unusual gastroscopic and an extremely rare histological finding. The aim of the authors was to draw the attention to gastric micropneumatosis, to summarize possible etiology and clinical features of this disorder.