Gastric emphysema after percutaneous endoscopic gastrostomy placement.

Emphysematous gastritis and gastric emphysema are different diseases. Sometimes, we treat the diseases without distinguishing them clearly because both are rare, and the mortality rate of emphysematous gastritis cases is high (55%). Gastric emphysema is more well known than is emphysematous gastritis after percutaneous endoscopic gastrostomy (PEG) placement (80%). Particularly, it is a self-healing disease, and treatment with antibiotics is not required. CT is commonly used to diagnose emphysematous gastritis and gastric emphysema. The amount of radiation exposure is a concern for performing multiple CTs following air disappearance in the gastric wall. Here, we report the case of a 92-year-old man with gastric emphysema after PEG. It was useful to follow-up the patient by performing radiographic examination, and the disease was managed conservatively without antibiotic administration. We report that distinguishing gastric emphysema from emphysematous gastritis was necessary. Moreover, performance excessive tests and treatments should be avoided.

Unexplained Abdominal Pain Caused by Fracture of the Thoracic Vertebra.

BACKGROUND It is important to identify the cause of chronic abdominal pain, especially in older adults. Thoracolumbar vertebral compression fractures are one potential cause, and can be difficult to identify. We report a case of an older man with severe unexplained abdominal pain and nausea due to an inadequately treated thoracolumbar vertebral compression fracture. CASE REPORT A 93-year-old man fell 89 days prior to visiting the hospital and was diagnosed with a compression fracture in the Th12 vertebra. He started wearing a corset on the day of the injury. Two days later, he developed abdominal pain, mild nausea, and a decreased appetite. He attributed the symptoms to wearing the corset; therefore, he stopped wearing it. The cause of his abdominal symptoms could not be determined by blood tests and computed tomography of the abdomen. A 45° upper body elevation induced marked right lower abdominal pain (consistent with the dominant region of Th12-L1), and decreased temperature sensation was observed in the same region. We concluded that the abdominal pain was caused by neuropathy owing to a ruptured Th12 vertebral fracture. The patient was treated conservatively, the abdominal pain and nausea resolved 7 weeks after admission, and the patient was discharged. CONCLUSIONS When assessing patients with unexplained abdominal pain, vertebral compression fractures should be included in the differential diagnosis and the necessary diagnostic assessments should be made as early as possible. Early diagnosis provides a wider range of treatment options and can contribute to minimizing functional decline.