So far the patient has been managed conservatively. The patient is doing well even a few weeks later.

Possible causes of gastric emphysema include:

• transient ischemia due to local or systemic hypoperfusion

• mucosal breach due to instrumentation or ulceration, or due to increased intra-gastric pressure (e.g. from forceful vomiting or gastric outlet obstruction)

• infection by gas-forming organisms (emphysematous gastritis), in which case the patient is seriously ill and CT may show portal venous gas

• spread of mediastinal gas

Given the clinical features and CT appearances, the likely etiology in this case is transient gastric ischemia. This is unusual due to the stomach’s rich arterial supply.