Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12430-12439
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12430
Phlegmonous gastritis after biloma drainage: A case report and review of the literature
Kai-Chun Yang, Hsin-Yu Kuo, Jui-Wen Kang
Kai-Chun Yang, Hsin-Yu Kuo, Jui-Wen Kang, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
Author contributions: Yang KC contributed to manuscript writing and editing, and data collection and analyses; Kuo HY and Kang JW supervised the study; Kang JW conceived the study; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jui-Wen Kang, MD, Attending Doctor, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan. kang1594@gmail.com
Received: September 10, 2022
Peer-review started: September 10, 2022
First decision: September 26, 2022
Revised: September 28, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: November 26, 2022
Processing time: 73 Days and 19.9 Hours
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.

Keywords: Phlegmonous gastritis; Epigastric pain; Choledocholithiasis; Bile leakage; Antibiotics; Case report

Core Tip: We report a case of spontaneous biloma caused by choledocholithiasis followed by phlegmonous gastritis (PG) resulting from biloma rupture after biloma drainage. Additionally, we analyzed 44 PG cases reported from 2012 to 2022. The etiology of PG is mainly direct microbial invasion from gastric mucosa injury or hematogenous/lymphogenous spread and the most important risk factor for PG is an immunocompromised state. In our case, the patient was immunocompetent and PG was caused by bile leakage after biloma drainage rather than the direct influence of infected biloma.