Phlegmonous Gastritis: A Report of Three Cases with Clinical and Imaging Features

Abstract

Phlegmonous gastritis is a rare but often fatal acute pyogenic infection of the stomach. We herein report three cases of phlegmonous gastritis with different causes: the long-term placement of a nasogastric feeding tube, bacteremia associated with cellulitis in a diabetic patient, and an adverse reaction to paclitaxel/carboplatin chemotherapy for cancer of unknown primary cause, which were classified as primary, secondary, and idiopathic types, respectively. Coping with the increasing morbidity rate associated with the diverse background of such patients requires a thorough understanding of the clinical features and image findings associated with this entity.

Sepsis caused by acute phlegmonous gastritis based on a group A Streptococcus

“…APG is most commonly caused by streptococcus, in particular the β-hemolytic Streptococcus group A ( Streptococcus pyogenes ) which is resistant to gastric acid [ 7 ]. Enterobacteriaceae, Staphylococus spp , Haemophilus influenza and endogenous bacteria of the oral cavity are also commonly involved and have been described [ 4 , 8 ].…”

A Case of Phlegmonous Gastritis in a Patient with Psoriatic Arthritis on Infliximab

“…In up to 41% of the cases, however, no risk factor can be identified [ 7 ]. Proton pump inhibitors and anti-H2 could also contribute to bacterial proliferation by increasing gastric pH [ 3 , 13 ].…”

“…According to a recent review of 45 cases, no difference on mortality has been observed between antibiotic and surgical treatment [ 1 ]. Duration of antibiotic therapy remains however variable according to the case reports, extending from 7 to 21 days [ 3 , 14 – 16 ]. Our patient had a favourable outcome with 14 days of a broad-coverage antibiotic.…”

“…Described for the first time in 1862 by Cruveilhier [ 1 ], it is caused by a bacterial infection of the gastric submucosa [ 2 ]. Primary and secondary forms have been defined [ 3 – 5 ]. Streptococcus is implicated in approximately 70% of cases [ 6 ], but many cases are believed to be polymicrobial [ 7 ].…”

“…On CT scan, the gastric wall will be thickened due to neutrophilic and plasmatic infiltration, with a low intramural density [ 3 ]. Endoscopic ultrasonography is believed to be more precise and could help distinguish phlegmonous gastritis from other submucosal lesions [ 7 , 10 ].…”