An 82-year-old man consulted for vomiting and transit arrest. He was obese with COPD, hemiplegia, myocar-dial infarction and pulmonary embolisms. He presented a distended and painless abdomen without guarding. Blood analysis showed only a mild renal insufficiency. The abdominal CT-scan showed a gastric distension with parietal pneumatosis and aeroportia (Fig. 1). These radiological features are commonly typical of intestinal necrosis requiring emergency surgical treatment and associated with a high mortality. This CT-scan was in contrast with an unremarkable physical examination and a watchful follow-up was decided. He improved quickly after gastric emptying and the control CT-scan showed a total regression, excluding a surgical decision. Presence of gas in the bowel wall and portal vein was not due to necrosis but probably correlated with high intra-luminal pressure, explaining air leakage across the gastric wall to the portal system [1]. The endoscopy did not find a mechanical cause for this distension, retaining an idio-pathic gastroparesia. The patient was progressively fed by mouth with a prokinetic treatment and was perfectly asymptomatic one month later. Aeroportia may be rarely due to a functional gastric occlusion and a conservative approach is warranted in the absence of clinical signs.
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