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1
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Sierra Beltrán E, Pascual Pérez E, García Maroto J. Acute phlegmonous gastritis: A diagnostic challenge for radiologists. RADIOLOGIA 2025; 67:231-233. [PMID: 40187816 DOI: 10.1016/j.rxeng.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/12/2024] [Indexed: 04/07/2025]
Affiliation(s)
- E Sierra Beltrán
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - E Pascual Pérez
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J García Maroto
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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2
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Shaik KS, Khatib MY, George S, Allafi SM, Peediyakkal MZ, Kannappilly N, Nashwan AJ. A case of phlegmonous gastritis complicated by stomach necrosis requiring gastrectomy. GASTROENTEROLOGY & ENDOSCOPY 2024; 2:38-41. [DOI: 10.1016/j.gande.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
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3
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Wang T, Xiao P, Xue J, Ma J, Zheng C. Abdominal pain in an adolescent girl with acute phlegmonous gastritis: a case report. J Int Med Res 2023; 51:3000605231202136. [PMID: 37968062 PMCID: PMC10652809 DOI: 10.1177/03000605231202136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/30/2023] [Indexed: 11/17/2023] Open
Abstract
Acute phlegmonous gastritis (APG), a rare clinical condition, is mainly characterized by bacterial invasion in the gastric lining and is associated with a high mortality rate. The symptoms of APG include abdominal pain, nausea, vomiting, fever, and infection. Notably, the lack of specificity in the clinical presentation presents challenges in the early diagnosis of the disease. APG is often prevalent in adults, with a higher incidence in men than women. However, patients of other ages may also be affected. We herein present a case report of a 12-year-old girl who was admitted to the hospital with gastrointestinal symptoms and fever. The patient's imaging findings were compatible with APG. Despite the requirement for surgical treatment in most cases of phlegmonous gastritis, our patient rapidly improved with imaging and antibiotic therapy. This case demonstrates the success of antibiotic therapy with early diagnosis.
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Affiliation(s)
- Tian Wang
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Peizhen Xiao
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Jiawen Xue
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Jiaojiao Ma
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Chunhua Zheng
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
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4
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Engiles JB, Uzal FA, Navarro MA, Reef VB, Bender SJ. Phlegmonous gastritis in 2 yearling horses. J Vet Diagn Invest 2022; 34:429-438. [PMID: 35000510 PMCID: PMC9254054 DOI: 10.1177/10406387211065044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Phlegmonous gastritis was diagnosed in 2 yearling fillies that were presented with a 1-wk history of fever, lethargy, and hypoproteinemia, associated with a previous diagnosis of equine proliferative enteropathy based on clinical signs and PCR assay detection of Lawsonia intracellularis in fecal samples. Abdominal ultrasound revealed enlargement of the stomach and expansion of its submucosal layer with hypoechoic fluid, as well as thickened hypomotile small intestinal segments. Given the poor prognosis and poor response to treatment, both horses were euthanized, one on the day of presentation and the other after 3 wk of intensive medical management including a combination of antimicrobials, analgesics, and intravenous colloids. At autopsy, acute mural gastritis characterized by severe submucosal edema with suppurative inflammation (i.e., phlegmonous gastritis) and necroulcerative enteritis compatible with the necrotizing form of equine proliferative enteropathy were identified in both horses. The gastric inflammation was associated with thrombosis and mixed bacterial populations, including Clostridium perfringens, that were confined to the submucosa without evidence of mucosal involvement; toxin genes compatible with C. perfringens type C were identified in one case. Human phlegmonous gastritis is an uncommon, often-fatal pyogenic infection that is often associated with mucosal injury, bacteremia, or immunocompromise. Our finding of this unusual gastric lesion in 2 horses with similar signalment, clinical disease, and spectrum of postmortem lesions suggests a similar etiopathogenesis that possibly involves local, regional, or distant hematogenous origin, and should be considered a potential complication of gastrointestinal mucosal compromise in horses.
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Affiliation(s)
- Julie B. Engiles
- Julie B. Engiles, University of
Pennsylvania, School of Veterinary Medicine, 382 West Street Rd, Kennett Square, PA 19348,
USA.
| | - Francisco A. Uzal
- California Animal Health and Food Safety Laboratory, San
Bernardino Branch, University of California–Davis, Davis, CA, USA
| | - Mauricio A. Navarro
- California Animal Health and Food Safety Laboratory, San
Bernardino Branch, University of California–Davis, Davis, CA, USA,Instituto de Patología Animal, Facultad de Ciencias
Veterinarias, Universidad Austral de Chile, Chile
| | - Virginia B. Reef
- Clinical Studies, School of Veterinary Medicine,
University of Pennsylvania, Kennett Square, PA, USA
| | - Susan J. Bender
- Departments of Pathobiology, School of Veterinary
Medicine, University of Pennsylvania, Kennett Square, PA, USA
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5
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Ponnampalam S, Lim CSH, Longano A, Wong E, Sayed-Hassen A. Phlegmonous gastritis: an unusual mimic of gastric cancer. ANZ J Surg 2021; 91:1945-1947. [PMID: 33448585 DOI: 10.1111/ans.16580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Shalini Ponnampalam
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Anthony Longano
- Department of Anatomical Pathology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Enoch Wong
- Upper Gastrointestinal Surgery Unit, Box Hill Hospital, Melbourne, Victoria, Australia.,Monash University Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Akhtar Sayed-Hassen
- Upper Gastrointestinal Surgery Unit, Box Hill Hospital, Melbourne, Victoria, Australia
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6
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Kim SK, Ko SH, Jeong KY, Lee JS, Choi HS, Hong HP. Acute Phlegmonous Gastritis Complicated by Subphrenic Abscess. J Emerg Med 2020; 60:e49-e52. [PMID: 33303274 DOI: 10.1016/j.jemermed.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Phlegmonous gastritis (PG) is a rare and potentially fatal disease characterized by bacterial infection of the gastric wall. However, its clinical features are nonspecific, which may delay its diagnosis and treatment. CASE REPORT We report a case of a previously healthy 53-year-old woman with localized PG complicated by subphrenic abscess formation who was treated successfully with antibiotics and percutaneous catheter drainage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment initiation are important to improving outcomes. Emergency physicians should consider PG a differential diagnosis of acute abdomen.
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Affiliation(s)
- Sung Kyoo Kim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seok Hoon Ko
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jong Seok Lee
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hoon Pyo Hong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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7
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Shi D, He J, Lv M, Liu R, Zhao T, Jiang Q. Phlegmonous gastritis in a patient with mixed-phenotype acute leukemia in the neutropenia phase during chemotherapy: A case report. Medicine (Baltimore) 2019; 98:e17777. [PMID: 31702630 PMCID: PMC6855575 DOI: 10.1097/md.0000000000017777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Phlegmonous gastritis is a rare bacterial infection of the gastric wall with high mortality. However, diagnosis of phlegmonous gastritis is difficult and standard treatment remains unestablished. PATIENT CONCERNS We report a 33-year-old male patient with mixed-phenotype acute leukemia who developed acute phlegmonous gastritis during the neutropenia phase on induction chemotherapy and was successfully treated. DIAGNOSES The patient was diagnosed with phlegmonous gastritis, which might be caused by Stenotrophomonas maltophilia on the basis of clinical manifestation, physical examination, enhanced computed tomography scan, histological finding, and microorganism culture of biopsied specimen in endoscopy. INTERVENTIONS The patient was treated with gastrointestinal decompression and broad-spectrum antibiotics. OUTCOMES He recovered from phlegmonous gastritis and received the 2nd cycle of chemotherapy with no complaint of abdominal discomfort. LESSONS Early recognition and proper management including broad-spectrum antibiotics are key approaches to phlegmonous gastritis.
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Affiliation(s)
- Dayu Shi
- Peking University People's Hospital, a Peking University Institute of Hematology, b Department of Gastroenterology, Beijing
| | - Jinde He
- Department of Gastroenterology, Peking University People's Hospital, Beijing
| | - Meng Lv
- Peking University People's Hospital, a Peking University Institute of Hematology, b Department of Gastroenterology, Beijing
| | - Rui Liu
- Peking University People's Hospital, a Peking University Institute of Hematology, b Department of Gastroenterology, Beijing
| | - Ting Zhao
- Peking University People's Hospital, a Peking University Institute of Hematology, b Department of Gastroenterology, Beijing
| | - Qian Jiang
- Peking University People's Hospital, a Peking University Institute of Hematology, b Department of Gastroenterology, Beijing
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu Province, China
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A Case of Phlegmonous Gastritis in a Patient with Psoriatic Arthritis on Infliximab. Case Rep Gastrointest Med 2018; 2018:3624627. [PMID: 30186641 PMCID: PMC6114249 DOI: 10.1155/2018/3624627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/18/2022] Open
Abstract
Phlegmonous gastritis is a pyogenic infection affecting the submucosa of the gastric wall. Although rarely diagnosed, it remains a disease with high mortality. We thereby describe the case of a 42-year-old male patient known for psoriatic arthritis on Infliximab who was diagnosed with phlegmonous gastritis secondary to immunosuppressive therapy. The patient had a favourable outcome with a conservative treatment consisting of a 14-day course of broad antibiotherapy.
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9
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Ramphal W, Mus M, Nuytinck HKS, van Heerde MJ, Verduin CM, Gobardhan PD. Sepsis caused by acute phlegmonous gastritis based on a group A Streptococcus. J Surg Case Rep 2018; 2018:rjy188. [PMID: 30093990 PMCID: PMC6077785 DOI: 10.1093/jscr/rjy188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/15/2018] [Indexed: 12/18/2022] Open
Abstract
We present a case of 45-year-old male with acute phlegmonous gastritis (APG) based on a hemolytic group A Streptococcus. APG is a rare and often a potentially fatal disease, which is characterized by a severe bacterial infection of the gastric wall. Because APG is a rapidly progressive disease, it comes with high mortality rates. Patients with an early diagnosis may undergo successful treatment and have a survival benefit. As soon as the diagnosis of APG is suspected, aggressive and adequate antibiotic treatment in combination with surgical intervention should be considered.
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Affiliation(s)
- Winesh Ramphal
- Department of Surgery, Amphia Hospital Breda, Breda, the Netherlands
| | - Marnix Mus
- Department of Surgery, Amphia Hospital Breda, Breda, the Netherlands
| | - Hans K S Nuytinck
- Department of Surgery, Amphia Hospital Breda, Breda, the Netherlands
| | - Marianne J van Heerde
- Department of Gastroenterology and Hepatology, Amphia Hospital Breda, Breda, the Netherlands
| | - Cees M Verduin
- Department of Microbiology and Infection Prevention, Amphia Hospital Breda, Breda, the Netherlands
| | - Paul D Gobardhan
- Department of Surgery, Amphia Hospital Breda, Breda, the Netherlands
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10
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Abstract
RATIONALE Acute phlegmonous gastritis (PG) is a rare and often fatal condition mainly characterized by severe bacterial infection of the gastric wall. Case reports of PG over the past century average about 1 per year. Early diagnosis and immediate treatment are crucial to achieve positive outcomes. PATIENT CONCERNS A 47-year-old man was referred to our hospital because of abdominal pain, high fever, and vomiting for 4 days, with aggravation for 24 hours. Physical examination revealed epigastric abdominal pain, rebound pain, and abdominal wall tightness. Abdominal CT showed thickening of the stomach wall with edema and gas. DIAGNOSES On the basis of symptoms and CT imaging findings, the patient was diagnosed with acute PG. INTERVENTIONS Antibiotic therapy and operation. OUTCOMES The patient immediately underwent an operation after conservative treatment using antibiotics proved ineffective. The whole stomach was obviously swollen, and the anterior side and posterior wall of the stomach were nigrescent necrotic. Hence, total gastrectomy was performed followed by reconstruction (roux-en-y), and pus that accumulated in the stomach wall was cultured. At postoperative broad-spectrum antibiotic coverage, the patient finally recovered. LESSONS Acute PG is a rare infection of the gastric wall especially after antibiotic treatment. Given the fast progression of this disease, early recognition and immediate action are crucial to achieve positive outcomes.
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11
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Kim KH, Kim CG, Kim YW, Moon H, Choi JE, Cho SJ, Lee JY, Choi IJ. Phlegmonous Gastritis with Early Gastric Cancer. J Gastric Cancer 2016; 16:195-199. [PMID: 27752398 PMCID: PMC5065950 DOI: 10.5230/jgc.2016.16.3.195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/22/2016] [Accepted: 06/30/2016] [Indexed: 12/18/2022] Open
Abstract
Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the stomach wall, with a high mortality rate. Antibiotics with or without surgical treatment are required for treatment. We present a case in which phlegmonous gastritis occurred during the diagnostic evaluation of early gastric cancer. The patient showed improvement after antibiotic treatment, but attempted endoscopic submucosal dissection failed because of submucosal pus. We immediately applied argon plasma coagulation since surgical resection was also considered a high-risk procedure because of the submucosal pus and multiple comorbidities. However, there was local recurrence two years later, and the patient underwent subtotal gastrectomy with lymph node dissection. Considering the risk of incomplete treatment immediately after recovery from phlegmonous gastritis and that recurrent disease can be more difficult to manage, delaying treatment and evaluation until after complete recovery of PG might be a better option in this particular clinical situation.
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Affiliation(s)
- Kyung Hee Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hae Moon
- Emergency Department, National Cancer Center, Goyang, Korea
| | - Jee Eun Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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12
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Matsumoto H, Ogura H, Seki M, Ohnishi M, Shimazu T. Fulminant phlegmonitis of the esophagus, stomach, and duodenum due to Bacillus thuringiensis. World J Gastroenterol 2015; 21:3741-3745. [PMID: 25834344 PMCID: PMC4375601 DOI: 10.3748/wjg.v21.i12.3741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/17/2014] [Accepted: 12/22/2014] [Indexed: 02/07/2023] Open
Abstract
We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-virulence bacilli can cause lethal gastrointestinal phlegmonous gastritis in conditions of immunodeficiency.
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13
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Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol 2014; 20:3383-3387. [PMID: 24696618 PMCID: PMC3964411 DOI: 10.3748/wjg.v20.i12.3383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/31/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient’s clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient’s condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.
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14
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Soga K, Kassai K, Itani K, Yagi N, Naito Y, Itoh Y. Gastric outlet obstruction induced by a gastric wall abscess after cholecystitis. Intern Med 2014; 53:2675-8. [PMID: 25447648 DOI: 10.2169/internalmedicine.53.2187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In December 2011, an 84-year-old Japanese man was admitted with severe cholecystitis. We treated the cholecystitis using antibiotics, and his symptoms improved. In March 2012, he was readmitted after experiencing a sudden bloating sensation and vomiting. We determined that a gastric wall abscess had protruded into the antrum. The gastric wall was adjacent to the gallbladder, and the gastric abscess was related to a known case of cholecystitis. Upper gastrointestinal endoscopy indicated that the abscess was under the mucous membrane of the gastric antrum. Pus, exuding from the abscess, was aspirated with an endoscope.
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Affiliation(s)
- Koichi Soga
- Department of Internal Medicine, Nishijin Hospital, Japan
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15
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Morimoto M, Tamura S, Hayakawa T, Yamanishi H, Nakamoto C, Nakamoto H, Ikebe T, Nakano Y, Fujimoto T. Phlegmonous gastritis associated with group A streptococcal toxic shock syndrome. Intern Med 2014; 53:2639-42. [PMID: 25400190 DOI: 10.2169/internalmedicine.53.2741] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Phlegmonous gastritis (PG) is a rare, acute, severe infectious disease of the gastric wall that is often fatal due to Streptococcus spp. A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. The patient expired less than 9 hours after admission despite intensive treatments. Later, an analysis of the blood and gastric juice revealed group A streptococcus (GAS) and virulence factors associated with toxic shock syndrome (TSS). We herein diagnosed a patient with an extremely aggressive course of PG caused by GAS TSS.
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16
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Ajibe H, Osawa H, Yoshizawa M, Yamamoto H, Satoh K, Koinuma K, Morishima K, Hosoya Y, Yasuda Y, Sugano K. Phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer. Therap Adv Gastroenterol 2011; 1:91-5. [PMID: 21180517 DOI: 10.1177/1756283x08095746] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.
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Affiliation(s)
- Hironari Ajibe
- Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan
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17
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Manejo conservador de una patología antigua: gastritis flemonosa aguda. Rev Clin Esp 2010; 210:e41-3. [DOI: 10.1016/j.rce.2010.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/13/2010] [Accepted: 04/19/2010] [Indexed: 12/27/2022]
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18
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Phlegmonous gastritis in a patient with myeloid sarcoma: a case report. Appl Immunohistochem Mol Morphol 2010; 17:458-62. [PMID: 19644358 DOI: 10.1097/pai.0b013e31819f86e2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Phlegmonous gastritis is a rare acute bacterial infection of the gastric wall with an extremely high mortality rate. Early diagnosis is crucial for immediate treatment that could improve the outcomes. Here we report a case in which a patient with underlying chronic myelomonocytic leukemia was diagnosed with phlegmonous gastritis on biopsy. This 57-year-old man presented with shortness of breath and intermittent upper quadrant abdominal pain for 4 days. Laboratory tests showed markedly increased white blood cell. A diagnosis of chronic myelomonocytic leukemia was made based on a peripheral blood smear and flow cytometry. Gastric biopsy showed suppurative inflammation in the submucosal region, prompting the diagnosis of phlegmonous gastritis. The patient was given empirical antibiotic treatment, and the white blood cell decreased dramatically. Surgical intervention was discussed but deferred. Despite continued antibiotics treatment, the patient died. The limited autopsy confirmed the diagnosis of phlegmonous gastritis. Immunohistochemical studies further revealed the occurrence of myeloid sarcoma that involved the gastrointestinal tract.
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19
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Hommel S, Savoye G, Lorenceau-Savale C, Costaglioli B, Baron F, Le Pessot F, Lemoine F, Lerebours E. Phlegmonous gastritis in a 32-week pregnant woman managed by conservative surgical treatment and antibiotics. Dig Dis Sci 2007; 52:1042-6. [PMID: 17342399 DOI: 10.1007/s10620-006-9235-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 01/08/2006] [Indexed: 12/13/2022]
Abstract
Phlegmonous gastritis is an extremely rare and life-threatening condition. We report the case of a 32-week pregnant women presenting a peritonitis owing to phlegmonous gastritis caused by a group A streptococcus and successfully managed by conservative surgical treatment and antibiotics. Multiple endoscopies with biopsies illustrate progressive and complete gastric recovery.
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Affiliation(s)
- Séverine Hommel
- Département d'hépatogastroenterologie et nutrition, Hôpital C Nicolle, 1 Rue de Germont, 76031 Rouen Cedex, France
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20
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Orel R, Mlinaric V, Stepec S, Luzar B, Brencic E, Cerar A. Acute phlegmonous gastritis associated with Helicobacter heilmannii infection in a child. Dig Dis Sci 2006; 51:2322-2325. [PMID: 17103036 DOI: 10.1007/s10620-006-9193-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 12/05/2005] [Indexed: 12/17/2022]
Affiliation(s)
- Rok Orel
- Division of Paediatrics, Department of Gastroenterology, University Medical Centre Ljubljana, Pediatricna klinika, Vrazov trg 1, 1000, Ljubljana, Slovenia.
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21
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Kim GY, Ward J, Henessey B, Peji J, Godell C, Desta H, Arlin S, Tzagournis J, Thomas F. Phlegmonous gastritis: case report and review. Gastrointest Endosc 2005; 61:168-74. [PMID: 15672083 DOI: 10.1016/s0016-5107(04)02217-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Gordon Y Kim
- Division of Gasteroenterology and Hepatology, the Ohio State University Medical Center, Columbus, OH 43210, USA
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Yokota T, Yamaki T, Yashima R, Yamada Y, Narushima Y, Kikuchi S, Yamauchi H, Hatori M. Emergency operation for phlegmonous gastritis. Ups J Med Sci 2005; 110:237-40. [PMID: 16454161 DOI: 10.3109/2000-1967-069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Phlegmonous gastritis is a rare inflammatory lesion in which bacterial infection occurs in the gastric wall. A case of phlegmonous gastritis producing an intramural filling defect in the stomach is presented. Endoscopy showed edematous and reddened gastric mucosa with a mass lesion in the gastric body and antrum. An abdominal CT scan showed diffuse and irregular thickening of the gastric wall. At emergency operation, a total gastrectomy with splenectomy was performed. The most important differential diagnosis is carcinoma, especially scirrhous-type gastric cancer. Radiographic findings of phlegmonous gastritis resemble those of scirrhous gastric cancer. More frequent recognition of this disease, early diagnosis and prompt institution of treatment is essential.
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Affiliation(s)
- Takashi Yokota
- Department of Surgery, National Sanatorium Tohoku Shinseien, Miyagi, Japan.
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23
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Jung C, Choi YW, Jeon SC, Chung WS. Acute diffuse phlegmonous esophagogastritis: radiologic diagnosis. AJR Am J Roentgenol 2003; 180:862-3. [PMID: 12591713 DOI: 10.2214/ajr.180.3.1800862] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cheolkyu Jung
- Hanyang University Seoul Hospital, Seoul 133-792, South Korea
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