Acute gastric necrosis after routine oesophagogastroduodenoscopy with therapeutic argon plasma coagulation

Abstract

A 56-year-old woman presented to the accident and emergency department with peritonitis 2 days after a routine oesophagogastroduodenoscopy. She was taken to theatre with the finding of gastric necrosis. Blood and peritoneal cultures grew group A haemolytic Streptococcus. Histology revealed normal vasculature, no volvulus but marked neutrophilia in the submucosa with an intact mucosa. The stomach was resected and the patient recovered in the intensive care unit but overwhelming acidosis progressed to multiorgan failure and treatment was eventually withdrawn. Acute phlegmonous gastritis has been well described in the literature but mainly before the advent of antibiotics. The most common organism is group A haemolytic Streptococcus (commonly found in throat infections) and predisposing factors include instrumentation. Should antibiotics be given at the start of an oesophagogastroduodenoscopy and should routine procedures be delayed if active upper respiratory tract infections are present?

Phlegmonous gastritis complicated by abdominal compartment syndrome: a case report

“…In our patient, acute ACS developed as a result of the following risk factors: large fluid resuscitation, acidosis, presence of ascites, and sepsis, with subsequent multiorgan failure [16]. As seen in our patient, deterioration can be rapid if undiagnosed and untreated, leading to acute peritonitis and death [4]. Up to 50% of ICU patients are at risk of developing intra-abdominal hypertension (IAH) and 8% are at risk for ACS [17].…”

“…Lastly, there are localized and diffuse forms of the disease with the latter form demonstrating significantly higher mortality rates (10% vs. 54%) [13,14]. Any mucosal injury can provide a route for bacterial penetration, and in this case, a background state of immunosuppression likely predisposed the patient to a fulminant bacterial infection [4]. Our case was classified as primary and diffuse.…”

“…Furthermore, rapid development of ACS, requires surgical decompression [16]. To our knowledge, this is only the sixth reported case of PG following routine endoscopic surveillance and random simple biopsy as part of a workup for anemia, and the only case reported with acute ACS as a complication [4][5][6][7].…”

“…To date, only six cases of post-endoscopy PG have been reported [4][5][6][7][8][9]. Patients presented with acute abdominal pain and/or nausea vomiting post-procedure, resulting in rapid deterioration [4][5][6][7][8]. Almost all patients and had to undergo total gastrectomy as their definitive management [4,[6][7][8][9].…”

“…Patients presented with acute abdominal pain and/or nausea vomiting post-procedure, resulting in rapid deterioration [4][5][6][7][8]. Almost all patients and had to undergo total gastrectomy as their definitive management [4,[6][7][8][9]. We encountered such a case, which was complicated by septic shock and abdominal compartment syndrome (ACS).…”