Korean J Gastroenterol.  2011 May;57(5):309-314. 10.4166/kjg.2011.57.5.309.

A Case of Acute Phlegmonous Gastritis Causing Gastroparesis and Cured with Medical Treatment Alone

• Kim NY
• Park JS
• Lee KJ
• Yun HK
• Kim JS

• KMID: 1792788
• DOI: http://doi.org/10.4166/kjg.2011.57.5.309

Abstract

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.

Keyword

Phlegmonous gastritis; Anti-bacterial agent; Gastroparesis

MeSH Terms

Acinetobacter/isolation & purification
Acute Disease
Aged
Anti-Bacterial Agents/*therapeutic use
Anti-Infective Agents/therapeutic use
Cefotaxime/therapeutic use
Ceftriaxone/therapeutic use
Ciprofloxacin/therapeutic use
Drug Resistance, Multiple, Bacterial
Drug Therapy, Combination
Gastritis/*diagnosis/drug therapy/microbiology
Gastroparesis/*diagnosis/microbiology
Gastroscopy
Humans
Imipenem/therapeutic use
Klebsiella oxytoca/isolation & purification
Male
Ofloxacin/therapeutic use
Pneumonia/diagnosis/drug therapy
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Gastroscopic findings. (A) Endoscopy (11 days earlier to admission) showed edematous necrotic- appearing mucosal fold thickening covered with bloody purulent exudates. (B) Endoscopy (5 days after admission) showed diffuse edematous mucosa with narrow lumen, yellowish pus overlying mucosa, and pocket exposed to the lumen. (C) Endoscopy (44 days after admission) showed markedly improved edematous antral mucosa with hyperemic scar formation. Body and fundus are normal. Arrow indicates endosopic sites corresponding to the abscess on CT.

• 

  Fig. 2. Abdominal CT findings. (A) CT (11 days earlier to admission) showed diffuse extensive gastric wall edema and thickening with hypodense area at the antrum. (B) Follow-up CT (2 days after admission) showed mild gastric wall edema at the body and fundus and abscess (arrow) in the thickened antrum and the posterior wall of the body. (C) Follow-up CT (23 days after admission) showed abscess resolution in the mildly edematous antrum and normal thickeness of the body and fundus.

• 

  Fig. 3. Gastric emptying time using 99m Tc-DTPA. (A) On time activity curve (15 days after admission) liquid emptying time was prolonged (T1/2: 43.5 min). (B) Follow-up emptying time (26 days after admission) was normal (T1/2: 13.5 min).

Reference

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