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Costa C, Antunes I, Lalanda R, Cruz R, Boavida J, Santos Silva J, Ribeiro J. An Under-Recognised Rapidly Fatal Condition: Phlegmonous Gastritis. Eur J Case Rep Intern Med 2025; 12:005175. [PMID: 40051743 PMCID: PMC11882003 DOI: 10.12890/2025_005175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 02/11/2025] [Indexed: 03/09/2025] Open
Abstract
Phlegmonous gastritis is a rare condition, characterised by an infectious process in the gastric wall. There is an association with haemolytic Streptococcus infection in approximately 70% of cases, less frequently with other infectious agents such as Staphylococcus aureus, Pneumococcus and Enterococcus. Diagnosis is often delayed due to non-specific symptoms, such as abdominal pain, nausea, vomiting and fever. Abdominal computed tomography (CT) typically reveals thickening of the gastric wall, low-intensity areas within the gastric wall and gas accumulation. The therapeutic approach includes broad-spectrum antibiotics, and surgical resection of the gastric area involved in complicated cases. The authors present the clinical case of a 58-year-old male admitted to the hospital with headache, vomiting, abdominal pain and fever. Laboratory evaluation showed increased inflammatory parameters. An abdominal CT scan showed markedly diffuse parietal thickening of the stomach with increased mucosal enhancement and densification of perigastric fat. There was rapid progression to septic shock and the patient was admitted to the intensive care unit. An urgent upper gastrointestinal endoscopy revealed diffuse oedema of the gastric mucosal with no signs of tumour infiltration, confirming the diagnosis of phlegmonous gastritis. Broad-spectrum antibiotic therapy was started, and the patient underwent an urgent total gastrectomy. Despite the interventions carried out, refractory shock with multi-organ dysfunction occurred, resulting in death. Histopathologic findings in the gastrectomy specimen were compatible with phlegmonous gastritis. The clinical case presented demonstrates the need for high clinical suspicion for an early diagnosis of phlegmonous gastritis, especially in patients with gastrointestinal symptoms and clinical severity, for early treatment and improvement of the prognosis. LEARNING POINTS Phlegmonous gastritis is a rare and deadly infectious disease of the gastric wall, mainly occurring in the submucosa of the stomach.Important diagnostic tools include CT imaging and gastroscopy. However, endoscopic findings may be varied and non-specific, making early diagnosis difficult.Conservative treatment using antibiotics may not work and urgent surgery may be needed.
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Affiliation(s)
- Cláudia Costa
- Serviço de Nefrologia e Transplantação Renal, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
| | - Inês Antunes
- Serviço de Medicina Intensiva, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
| | - Raquel Lalanda
- Serviço de Cirurgia, Unidade de Cirurgia Esófago-Gástrica, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
| | - Rafael Cruz
- Serviço de Anatomia Patológica, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
| | - João Boavida
- Serviço de Anatomia Patológica, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
| | - João Santos Silva
- Serviço de Medicina Intensiva, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
| | - João Ribeiro
- Serviço de Medicina Intensiva, Unidade Local de Saúde Santa Maria, Lisboa, Portugal
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Yang KC, Kuo HY, Kang JW. Phlegmonous gastritis after biloma drainage: A case report and review of the literature. World J Clin Cases 2022; 10:12430-12439. [PMID: 36483820 PMCID: PMC9724512 DOI: 10.12998/wjcc.v10.i33.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND 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. CASE SUMMARY 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. CONCLUSION PG should be considered in patients with intraabdominal infection, especially from infected organs adjacent to the stomach.
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Affiliation(s)
- Kai-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Jui-Wen Kang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
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Saito M, Morioka M, Izumiyama K, Mori A, Ogasawara R, Kondo T, Miyajima T, Yokoyama E, Tanikawa S. Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report. World J Clin Cases 2021; 9:6493-6500. [PMID: 34435017 PMCID: PMC8362572 DOI: 10.12998/wjcc.v9.i22.6493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Phlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is Streptococcus pyogenes, followed by Staphylococcus, Pneumococcus and Enterococcus. Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG. CASE SUMMARY The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy. Her vital signs were consistent with septic shock. Venous blood culture revealed the presence of Bacillus cereus. Abdominal computed tomography (CT) and esophagogastroduodenoscopy (EGD) showed marked thickening of the gastric wall. As with the other findings, CT was suggestive of HPVG, and EGD showed pseudomembrane-like tissue covering the superficial mucosa. Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils. Culture of gastric specimens revealed the presence of Bacillus cereus. We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG. This patient recovered successfully with conservative treatment, chiefly by using carbapenem antibiotics. CONCLUSION The histopathological finding of this gastric biopsy specimen should be called "neutropenic necrotizing gastritis".
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Toru Miyajima
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Emi Yokoyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Satoshi Tanikawa
- Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 0608638, Hokkaido, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo 001-0021, Hokkaido, Japan
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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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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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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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7
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Phlegmonous gastritis associated with advanced esophageal cancer. Clin J Gastroenterol 2018; 11:371-376. [DOI: 10.1007/s12328-018-0867-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
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8
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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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9
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Odai T, Hibino T. [The Abdominal Ultrasonographic Appearance of Acute Phlegmonous Gastritis]. ACTA ACUST UNITED AC 2016; 90:113-9. [PMID: 27197437 DOI: 10.11150/kansenshogakuzasshi.90.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Phlegmonous gastritis (PG) is a nonspecific suppurative inflammation disease arising from the submucosal layer, and extending to the full thickness of the stomach. We herein report on a case of acute PG which was diagnosed with abdominal ultrasonography. A 64-year-old man presented at a hospital after having recently undergone pacemaker implantation for the treatment of complete atrioventricular block. He was admitted as an emergency due to a fever of 39 degrees C. He showed anorexia, epigastralgia, vomiting of coffee-ground emesis on the second hospital day, and abdominal ultrasonography (AUS) performed on the third hospital day showed the disappearance of the normal laminated structure and hypoechoic thickening of the stomach walls. Upper gastrointestinal endoscopy revealed significant hyperplasia of the stomach walls, an erythrogenic mucosa, and poor extension. On the fourth hospital day, computed tomography revealed concentric thickening of the stomach walls. Streptococcus pyogenes was cultured from his blood sample. Based on those findings, the patient was diagnosed as having acute phlegmonous gastritis. His clinical symptoms improved and the abnormal ultrasonographic examination findings thereafter returned to normal following the administration of antibiotics. PG should therefore be included in the differential diagnosis when encountering patients with acute abdomen. We experienced a rare case of acute phlegmonous gastritis and AUS was useful for making an early diagnosis.
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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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12
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Cortes-Barenque F, Salceda-Otero JC, Angulo-Molina D, Lozoya-González D. Acute phlegmonous gastritis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:299-301. [PMID: 25453722 DOI: 10.1016/j.rgmx.2014.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/09/2014] [Accepted: 07/14/2014] [Indexed: 12/17/2022]
Affiliation(s)
- F Cortes-Barenque
- Servicio de Endoscopia Gastrointestinal, Centro Médico ABC, México, D.F., México
| | - J C Salceda-Otero
- Servicio de Endoscopia Gastrointestinal, Centro Médico ABC, México, D.F., México; Ultrasonido Endoscópico, Centro Médico ABC, México, D.F., México.
| | - D Angulo-Molina
- Servicio de Endoscopia Gastrointestinal, Centro Médico ABC, México, D.F., México
| | - D Lozoya-González
- Servicio de Endoscopia Gastrointestinal, Centro Médico ABC, México, D.F., México
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Cortes-Barenque F, Salceda-Otero J, Angulo-Molina D, Lozoya-González D. Acute phlegmonous gastritis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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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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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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Fan JQ, Liu DR, Li C, Chen G. Phlegmonous gastritis after esophagectomy: A case report. World J Gastroenterol 2013; 19:1330-1332. [PMID: 23482416 PMCID: PMC3587494 DOI: 10.3748/wjg.v19.i8.1330] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/03/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
Phlegmonous gastritis is an unusual infection of the gastric wall, which is extremely rare and associated with a poor prognosis. Here, we report the case of a 65-year-old male patient with a history of splenectomy, who had phlegmonous gastritis after esophagectomy. Computed tomography revealed a remarkably distended thoracic stomach, and the gastric wall was locally thickened. Gastric mucosa was red and white in color and significantly edematous on gastroscopy. He was successfully treated with a combination of antibiotics and povidone-iodide intraluminal lavage. In addition to this case, the clinical presentations, imaging examinations as well as treatments of phlegmonous gastritis are discussed.
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Itonaga M, Ueda K, Ichinose M. Phlegmonous gastritis caused by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Dig Endosc 2012; 24:488. [PMID: 23078457 DOI: 10.1111/j.1443-1661.2012.01362.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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