Gastric pneumatosis and hepatoportal venous gas in superior mesenteric artery syndrome: a case report.

Background: Gastric pneumatosis is a rare condition characterized by the presence of air within the stomach wall. It can range from benign conditions to potentially fatal complications. It can be classified as gastric emphysema or emphysematous gastritis. Hepatic portal venous gas, which is often linked to high mortality rates, presents a controversial decision regarding the necessity of surgical intervention. This rare case of gastric pneumatosis and hepatic portal venous gas is notable for its association with superior mesenteric artery syndrome, an uncommon underlying cause, and highlights the potential for a benign outcome despite alarming initial signs.

Case presentation: This is a case of an 87-year-old Lebanese Middle Eastern female patient who presented with diffuse abdominal pain and severe postprandial vomiting, which showed gastric emphysema and hepatoportal venous gas due to superior mesenteric artery syndrome upon investigation. While worrisome findings on radiological imaging and gastric endoscopy favor urgent surgical intervention, this patient was managed conservatively with successful outcomes before proceeding to surgery to treat the atypical underlying causative superior mesenteric artery syndrome. Endoscopic images illustrate the dramatic initial presentation and unexpected clinical improvement, highlighting the unique aspects of this case.

Conclusion: This case highlights the rare occurrence of gastric pneumatosis with hepatic portal venous gas linked to superior mesenteric artery syndrome and highlights both the severity of initial symptoms and their benign resolution, focusing on the unexpected clinical variability of superior mesenteric artery syndrome. These findings suggest that conservative management can lead to favorable outcomes, challenging the typical urgency for surgical intervention in such alarming cases. The overall clinical picture, including the underlying etiology, clinical examination, and laboratory parameters should be considered when making treatment decisions.