Abstract
Emphysematous gastritis is a rare, often fatal infection of the stomach wall characterized by gas formation and tissue necrosis, most frequently associated with polymicrobial infections. Cases with demonstration of tissue invasion by Clostridium species are exceptionally uncommon. We report the case of a 77-year-old woman with multiple comorbidities, including diabetes mellitus, obesity, atherosclerosis, and chronic kidney disease, who presented with severe abdominal pain, nausea, and vomiting. Imaging revealed gastric emphysema with pneumoperitoneum. Emergent laparotomy demonstrated full-thickness necrosis of the stomach along the lesser curvature, necessitating total gastrectomy with Roux-en-Y esophagojejunostomy and splenectomy. Histopathology confirmed extensive necrosis with gas dissection and abundant gram-positive, boxcar-shaped bacilli consistent with Clostridium perfringens. This case highlights the pathogenic potential of C. perfringens to cause spontaneous, necrotizing emphysematous gastritis in the absence of trauma or malignancy. Vascular compromise from severe atherosclerosis and thrombosis likely contributed to tissue hypoxia, creating a permissive environment for clostridial invasion. A literature review identified only a handful of human cases of emphysematous gastritis with definitive Clostridium identification, most with fatal outcomes unless surgically managed. CONCLUSION: Emphysematous gastritis associated with Clostridium species is exceedingly rare and rapidly progressive. Early recognition and aggressive surgical resection appear to offer the best chance of survival. Clinicians should maintain a high index of suspicion in high-risk patients presenting with acute abdominal symptoms and gastric wall emphysema.