Endosonographic diagnosis and follow‐up of phlegmonous gastritis

Abstract

We report a case of phlegmonous gastritis in a 36-year-old man presenting with anorexia, epigastralgia, and high fever. Endoscopy showed an edematous lesion suggesting a submucosal lesion. Endosonography revealed thickening of the gastric wall, mainly involving the submucosa, with a few anechoic areas. The separation between the submucosa and the muscularis propria was unclear. The patient was treated with antibiotics and endoscopic mucosal resection. Culture of the aspirated pus from the lesion revealed Streptococcus pyogenes. Follow-up endosonography performed 1 week later showed significant improvement.

Endoscopic sonography in the diagnosis and treatment of a gastric wall abscess: A case report and review of the literature

“…Recently, endoscopic drainage by mucosa resection with snare, needle‐knife incision and forceps with or without antibiotics has been reported to be successful (Table 2). 2, 3, 10, 12, 16–18 Percutaneous drainage with antibiotics has also been reported 5, 19. Therefore, once a gastric wall abscess is diagnosed, EUS‐guided endoscopic therapy (as performed in the presented case) may promptly drain the abscess in the least invasive way.…”

“…5, 7–14 A gastric wall abscess has a sonographic appearance that is inhomogeneous with a predominant hypoechoic lesion located mainly in the muscularis propria or the submucosa layer. EUS findings of a diffuse gastric wall abscess are demonstrated by thethickening of the gastric wall, mainly in the submucosa, with a blurred interface between the submucosa and muscularis propria 9, 10. A complete absence of all of the wall layers has also been reported 7.…”

Phlegmonous Gastritis and Streptoccocal Toxic Shock Syndrome: An Almost Lethal Combination

“…Table 2 summarizes cases of acute phlegmonous gastritis published between 2010 and 2019 caused by S. pyogenes . 1 , 8 , 9 , 14 – 20 In this review, 10 published cases showed: (a) the worldwide distribution of the disease, (b) the manifestation of STSS associated with septic shock and multi-organ failure (8/10), and (c) the high mortality rate associated with the disease (3/10 deaths). In three of the cases, the responsible microorganism was isolated from the blood while gastrectomy was necessary for four patients.…”

Phlegmonous Gastritis Associated with Group A Streptococcal Toxic Shock Syndrome

“…Diagnosis using GI endoscopy, particularly EUS, is considered to be the best approach. EUS can accurately identify gastric wall thickening, degree of inflammation, and other conditions (8,9). In addition, complex evaluations combining gastric juice cultures with a pathological examination of the biopsy samples obtained with the endoscope enable a definitive diagnosis to be made.…”