Emphysematous gastritis: diagnostic histology in the absence of classic radiological features

Emphysematous gastritis is a rare and life-threatening condition often caused by gas-forming bacterial infections. This case describes a woman in her 40s with no significant medical history, presenting with acute abdominal pain, nausea and vomiting. Cross-sectional imaging was non-diagnostic. An oesophagogastroduodenoscopy showed patches of highly unusual cobblestone gastric mucosa, but no definitive diagnosis could be made until histology confirmed emphysematous gastritis. The patient was treated with broad-spectrum intravenous antibiotics, including flucloxacillin, metronidazole and gentamicin. She improved with conservative management, avoiding the need for surgery. This case highlights the importance of early clinical suspicion and using a multidisciplinary approach with endoscopic, microbiological and histological correlation in diagnosing emphysematous gastritis.