Phlegmonous gastritis in a haemodialysis patient with secondary amyloidosis

[Phlegmonous Gastritis Caused by Penetration of a Toothpick]

Phlegmonous gastritis is a disease caused by a bacterial infection of the gastric wall. This condition is rare, but when it does occur, its prognosis appears to be poor. The underlying etiology is largely unknown, but an immunocompromised state is considered an important risk factor. An 85-year-old woman presented with a confused mentality, fever, epigastric pain, and melena. There was no history of alcohol drinking or smoking, nor of previous gastric surgery. On the other hand, there was a history of senile dementia and cognitive impairment. Initial contrast-enhanced abdominal CT revealed gastric wall edema at the antrum with mucosal hyper-enhancement and an abscess in the thickened antrum. Upper gastrointestinal endoscopy on the fourth hospital day showed dark-colored fluid retention in the stomach. The gastric mucosa was inflamed and friable, with several ulcerative lesions showing purulent discharge. A toothpick was found in the process of identifying the base of the ulcerative lesion and was removed. Eventually, phlegmonous gastritis due to the penetration of a toothpick was diagnosed. After endoscopic toothpick removal, the patient's symptoms improved dramatically. Serial endoscopy revealed improvement in the gastric mucosa. This case is an example of phlegmonous gastritis caused by a foreign substance in the gastric wall of a patient with senile dementia. During upper gastrointestinal endoscopy in this case, identification of the base of ulcerative lesion played a critical role in the diagnosis.

Lethal phlegmonous colitis

A 52-year-old man died soon after admission to hospital with a severe metabolic acidosis and likely sepsis. He had a past history of alcohol abuse with withdrawal seizures. An abdominal computed tomography scan showed thickened bowel loops but no obvious ischaemic changes, and a blood culture yielded a pure growth of Escherichia coli. At autopsy, the liver showed well-established micro-nodular cirrhosis with steatosis. The peritoneal cavity contained 200 mL of turbid yellow-brown fluid, and the caecum and ascending colon were unusually thickened. Microscopy of the caecum and ascending colon showed oedema, with a florid submucosal acute inflammatory infiltrate and large numbers of rod-shaped bacilli typical of phlegmonous colitis. This rare acute infectious condition predominately involves the caecum and ascending colon and is associated with liver cirrhosis. It should therefore always be considered at autopsy in individuals with cirrhosis, with careful examination and microscopic sampling of the caecum and proximal ascending colon, including ancillary blood/fluid bacterial cultures if the condition is suspected based on the macroscopic findings and/or history.

[A case of acute phlegmonous gastritis causing gastroparesis and cured with medical treatment alone]

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

A case of phlegmonous gastritis associated with marked gastric distension

Phlegmonous gastritis is an acute and severe infectious disease that is occasionally fatal if the diagnosis is delayed. Alcohol consumption, an immunocompromised state (e.g., due to HIV infection, rheumatoid arthritis, diabetes mellitus, or adult T-cell lymphoma), and mucosal injury of the stomach are reported to be predisposing factors. The main treatments for phlegmonous gastritis are antibiotics administration or surgery. In this case, the patient's stomach was markedly distended due to long-lasting gastric-outlet obstruction, which is thought to be the predisposing factor for phlegmonous gastritis. We inserted a metal stent at the obstructed site palliatively due to strong refusal by the patient for surgery. The patient recovered after stenting and antibiotic therapy.

Acute phlegmonous gastritis in an infant

The authors present a case of acute phlegmonous gastritis occurring in an 11-month-old infant in whom the diagnosis was made by microscopic examination after surgery for perforation of the stomach. The patient recovered uneventfully. The pathogenesis, diagnosis, and treatment in this inflammatory process are discussed.

CT features of acute phlegmonous gastritis

One case of phlegmonous gastritis is presented. Radiological diagnosis of this condition is difficult. In the setting of a clinical suspicion of this condition, computed tomography (CT) is the imaging modality of choice.