Emphysematous Gastritis in the Setting of Stage Four Colon Cancer After Radiation Therapy and Ongoing Chemotherapy: A Case Report.

Emphysematous gastritis (EG) is a rare, life-threatening condition characterized by air in the stomach wall due to gas-producing bacteria, often accompanied by portal venous air. This case report describes a 50-year-old male with stage 4 colon cancer, undergoing cytarabine chemotherapy, who presented with sepsis, altered mental status, and melena. A CT scan revealed gastric pneumatosis and portal venous air, prompting urgent diagnostic laparoscopy and intraoperative esophagogastroduodenoscopy, which showed patchy mucosal ischemia without transmural involvement. Blood cultures identified Pseudomonas and Klebsiella oxytoca, which were treated with cefepime and metronidazole, alongside oral vancomycin for Clostridioides difficile. The patient recovered without EG-related complications over four weeks and was discharged to home hospice. Emphysematous gastritis is not commonly reported in the setting of chemotherapy for colon cancer. This case highlights the efficacy of conservative management in EG and underscores the need for heightened awareness of this condition in oncologic patients receiving chemotherapy.