Gastric abscess is a rare condition caused by gastric barrier damage. It is easily misdiagnosed in clinical practice as a cancer recurrence or submucosal tumor, especially after surgery or endoscopic submucosal dissection. With a relatively high mortality rate, the cause and clinical characteristics of gastric abscesses are obscure. To date, diagnostic evaluations have mostly included indirect gastroscopy and abdominal computed tomography. A definite diagnosis of gastric abscess is challenging, and unnecessary surgery is sometimes performed. Relatively few applications of endoscopic ultrasound (EUS) have been described. EUS-guided fine needle aspiration for diagnosis and drainage is not commonly used. Therefore, more experiences related to the cause and clinical characteristics of gastric abscesses should be reported. Further recognition of EUS ultrasonographic images and related minimally invasive EUS therapies are urgently needed. Herein, through a literature review of previous cases, we summarized the causes, clinical features, and diagnostic methods for gastric abscess. Moreover, we aimed to gain more experience diagnosing gastric abscesses by EUS for future differentiation and treatment strategies by endoscopy.

Phlegmonous gastritis (PG) is a rare bacterial infection of the gastric submucosa and is related to septicemia, direct gastric mucosal injury, or the direct influence of infection or inflammation in neighboring organs. Here, we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage.

A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d. Physical examination showed stable vital signs, icteric sclera, diffuse abdominal tenderness, and muscle guarding. Laboratory tests showed hyperbilirubinemia and bandemia. Contrast computed tomography (CT) of the abdomen showed a dilated common bile duct and left subphrenic abscess. Left subphrenic abscess drainage revealed bilious fluid, and infected biloma was confirmed. Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening. Esophagogastroduodenoscopy (EGD) showed an edematous, hyperemic gastric mucosa with poor distensibility. The gastric mucosal culture yielded Enterococcus faecalis. PG was diagnosed based on imaging, EGD findings, and gastric mucosal culture. The patient recovered successfully with antibiotic treatment.

PG should be considered in patients with intraabdominal infection, especially from infected organs adjacent to the stomach.