Acute phlegmonous gastritis

Abstract

Summary A fatal case of acute phlegmonous gastritis in a 30 year old man is reported. It was caused by Group A Streptococcus (M type 1, T type 1). Although extremely rare, clinicians need to be aware of this condition as, without intervention, it is rapidly fatal. The recommended treatment is antibiotics combined with surgical resection.

Acute gastric necrosis after routine oesophagogastroduodenoscopy with therapeutic argon plasma coagulation

“…Nevertheless, over recent years, there has been a rise in incidence in the Western world. 8 With ever increasing numbers of endoscopies performed and more therapeutic interventions undertaken, it is important to be aware of this potentially devastating complication of endoscopy.…”

Phlegmonous Gastritis

“…The gastric submucosa may become infected either through direct contact with ingested pathogens, possibly swallowed sputum from a respiratory tract infection, or through haematogenous spread from a distant site of infection [3], In the first setting, any impairment of gastric mucosal integrity, such as following gastritis, peptic ulcer ation, gastric carcinoma, or corrosive ingestion, may pro vide a port of entry to the submucosa and initiate the infective process. In our patient the chronic empyema appeared to have developed as a complication of tubercu lous scarring of the lungs.…”

“…Alphahemolytic Streptococcus is the organism isolated in approximately 70% of cases, however, Pneumococci, E. coli, Staphylococcus aureus, Proteus and Clostridium welchii have been identified [3], The condition was known to Galen and was first described by Cruveilheir [1] in 1862, and by 1919 Sundberg had reviewed 215 cases [3], Subse quent to the advent of antibiotics the incidence has decreased dramatically, and only 39 cases have been reported since 1945 [2], In a review of 23 patients. Miller et al [4] noted an association between phlegmonous gas tritis and recent large intake of alcohol, upper respiratory tract infection and gastritis.…”

“…Plain abdominal radiographs are abnormal in 50% of the cases [4]: findings include paralytic ileus, depres sion of the gastric shadow and elevation of the left hernidiaphragm [16.17], The appearance of gas bubbles within the gastric wall is suggestive of emphysematous gastritis [7], often associated with a clostridial infection. Contrast studies may demonstrate absent peristalsis, gastric dilata tion, edematous gastric folds or an intraluminal filling defect suggestive of malignancy [14], Ultrasound exami nation of the abdomen may reveal a bulky, thickened gas tric wall [3], and CT scan has been used to identify an intramural abscess [11]. Endoscopic features include fundal ulceration and the presence of a fibrinopurulent exu date resembling 'raw minced meat' [2], In this setting a deep biopsy adequately sampling the submucosa is esential to establish the diagnosis.…”

Peptic ulcer disease in children

“…121 Acute emphysematous gastritis is an often-fatal complication of phlegmonous gastritis in which gastric wall infection is caused by gas-forming bacteria. 122±125 Predisposing factors include the ingestion of caustic agents and abdominal surgery; it has also been reported in a leukaemic child 124 , a child with a phytobezoar 122 and a patient who ingested large volumes of a carbonated beverage.…”