J Korean Med Sci.  2010 Oct;25(10):1532-1535. 10.3346/jkms.2010.25.10.1532.

Acute Diffuse Phlegmonous Esophagogastritis: A Case Report

• Kim HS
• Hwang JH
• Hong SS
• Chang WH
• Kim HJ
• Chang YW
• Kwon KH
• Choi DL

• KMID: 2157863
• DOI: http://doi.org/10.3346/jkms.2010.25.10.1532

Abstract

Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.

Keyword

Phlegmonous Infection; Esophagogastritis; Computed Tomography

MeSH Terms

Acute Disease
Cellulitis/complications/*diagnosis/radiography
Drainage
Esophagitis/complications/*diagnosis/surgery
Gastritis/complications/*diagnosis/surgery
Humans
Klebsiella Infections/diagnosis
Klebsiella pneumoniae/isolation & purification
Male
Middle Aged
Pleural Effusion/etiology/radiography
Thoracostomy
Tomography, X-Ray Computed

Figure

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  Fig. 1 Chest radiograph on admission: a chest radiograph obtained on admission shows widening of the mediastinum and the carinal angle with bilateral pleural effusion.

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  Fig. 2 Initial and post-opearative follow-up chest CT scans. (A, B) Initial chest CT scan with axial (A) and coronal (B) reformation reveals diffuse wall thickening with intramural low density (arrowheads) along the entire length of the thoracic esophagus extending to gastric cardia. Multiloculated bilateral pleural effusion, which proved to be empyema, is also shown. (C) Follow-up chest CT after surgery shows a marked improvement of the diffuse esophageal wall thickening and empyema.

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