Phlegmonous gastritis diagnosed by endoscopic snare biopsy

Bron, B; Deyhle, P; Pelloni, S; Krejs, G. J.; Siebenmann, R

doi:10.1007/bf01078356

Cited by 26 publications

(4 citation statements)

References 4 publications

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“…The disease is often confused with infiltrating gastric carci− noma (Borrmann type IV) [8], and differentiating the two dis− eases is very difficult. Phlegmonous gastritis can be diagnosed by endoscopic snare biopsy without gastrectomy [9]. Microscop− ically, there is an infiltration of polymorphonuclear leukocytes in the submucosa and necrotic mucosa.…”

Section: Discussionmentioning

confidence: 99%

Phlegmonous Gastritis after Endoscopic Mucosal Resection

Lee¹,

Kim²,

Seong³

et al. 2005

Endoscopy

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IntroductionPhlegmonous gastritis is a rare complication of endoscopic pro− cedures, or may occur in the fetus [1]. Two cases have been re− ported: one followed India ink marking and the other followed polypectomy [2,3]. Several conditions can predispose to the de− velopment of phlegmonous gastritis, including conditions asso− ciated with reduced immune response, gastrointestinal bleeding, and abdominal surgery [4,5]. We encountered a case of phleg− monous gastritis and report it here because of its rarity. Case ReportA 68−year−old woman was transferred to the Department of In− ternal Medicine because of a gastric adenoma. Her vital signs in the endoscopy room were normal, and all her laboratory test re− sults were normal. Endoscopic examination before endoscopic polypectomy showed an elevated mass (0.7 cm 0.7 cm) at the lesser curvature of the antrum (Figure 1 a). We performed an en− doscopic mucosal resection. Eight hours later, she visited the emergency room because of epigastric pain and fever. She looked acutely ill; her blood pressure was 180/90 mm Hg, pulse 88 beats per minute, and body temperature 38.58 C. Her white blood cell count was 11890/mm 3 and her hemoglobin was 14.9 g/dl. No free air was seen on the chest radiograph.A thickened, edematous gastric wall, especially in the antral area, was found on endoscopy (Figure 1 b), but no ulceration or pus was seen. Abdominopelvic computed tomography revealed dif− fuse thickening of the gastric wall (Figure 1 c). We started anti− biotic treatment about 20 hours after the endoscopic mucosal re− section. On day 4 of her hospital stay, follow−up CT showed im− provement in the gastric−wall thickening and perigastric hazi− ness, and her symptoms were relieved. Enterococcus fecalis was cultured from her gastric secretions. Endoscopic biopsy showed histological evidence of acute and chronic gastritis. Antibiotic treatment was continued until day 14 and she was discharged on day 15.One week later, she developed epigastric pain and watery diar− rhea, accompanied by fever, and she visited the outpatient clinic. She was readmitted and given combined antibiotic treatment. Despite this, her fever persisted. Moreover, she had fluctuating Abstract Phlegmonous gastritis, or acute suppurative gastritis, is a rare, life−threatening condition which is characterized by purulent necrosis and thickening of the gastric wall. A combination of gastrectomy and antibiotic therapy is an effective treatment. We report a rare case of phlegmonous gastritis occurring after endoscopic mucosal resection. The patient was treated initially with antibiotic therapy but eventually required surgery. Case Report 490Downloaded by: Karolinska Institutet. Copyrighted material.

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Section: Discussionmentioning

confidence: 99%

Phlegmonous Gastritis after Endoscopic Mucosal Resection

Lee¹,

Kim²,

Seong³

et al. 2005

Endoscopy

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“…However it is noteworthy that even without such apparent underlying conditions, phlegmonous gastritis develops after endoscopic procedures. Bron et al reported on a patient who developed phlegmonous gastritis after endoscopic snare biopsy [Bron et al 1977]. Another case of phlegmonous gastritis after endoscopic mucosal resection (EMR) of smaller size that required total gastrectomy has been reported [Lee et al 2005].…”

Section: Discussionmentioning

confidence: 99%

Phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer

Ajibe

Osawa

Yoshizawa

et al. 2008

Therap Adv Gastroenterol

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A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.

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“…However, it is often difficult to diagnose them during endoscopy because the inflammation involves predominantly the submucosa. 3 We report the endosonographic and endoscopic findings in a case of phlegmonous gastritis.…”

Section: Received 27 June 2006; Accepted 6 January 2007mentioning

confidence: 98%

Endosonographic diagnosis and follow‐up of phlegmonous gastritis

Kanno

Irisawa

Takagi

et al. 2007

J of Clinical Ultrasound

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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.

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Phlegmonous gastritis diagnosed by endoscopic snare biopsy

Cited by 26 publications

References 4 publications

Phlegmonous Gastritis after Endoscopic Mucosal Resection

Phlegmonous Gastritis after Endoscopic Mucosal Resection

Phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer

Endosonographic diagnosis and follow‐up of phlegmonous gastritis

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