J Gastric Cancer.  2016 Sep;16(3):195-199. 10.5230/jgc.2016.16.3.195.

Phlegmonous Gastritis with Early Gastric Cancer

• Kim KH
• Kim CG
• Kim YW
• Moon H
• Choi JE
• Cho SJ
• Lee JY
• Choi IJ

• KMID: 2372564
• DOI: http://doi.org/10.5230/jgc.2016.16.3.195

Abstract

Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the stomach wall, with a high mortality rate. Antibiotics with or without surgical treatment are required for treatment. We present a case in which phlegmonous gastritis occurred during the diagnostic evaluation of early gastric cancer. The patient showed improvement after antibiotic treatment, but attempted endoscopic submucosal dissection failed because of submucosal pus. We immediately applied argon plasma coagulation since surgical resection was also considered a high-risk procedure because of the submucosal pus and multiple comorbidities. However, there was local recurrence two years later, and the patient underwent subtotal gastrectomy with lymph node dissection. Considering the risk of incomplete treatment immediately after recovery from phlegmonous gastritis and that recurrent disease can be more difficult to manage, delaying treatment and evaluation until after complete recovery of PG might be a better option in this particular clinical situation.

Keyword

Phlegmonous gastritis; Early gastric cancer; Endoscopic submucosal dissection

MeSH Terms

Anti-Bacterial Agents
Argon Plasma Coagulation
Bacterial Infections
Cellulitis*
Comorbidity
Gastrectomy
Gastritis*
Humans
Lymph Node Excision
Mortality
Recurrence
Stomach
Stomach Neoplasms*
Suppuration
Anti-Bacterial Agents

Figure

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  Fig. 1 Development and diagnosis of phlegmonous gastritis. Initial endoscopy shows a 1.2-cm ill-defined lesion suspicious for early gastric cancer at the distal antrum (A) and superficial gastritis at the proximal antrum (B). (C) Abdominal computed tomography shows diffuse extensive gastric wall edema and an air bubble in the antrum. (D, E) Endoscopy was repeated a day after initial endoscopy, and shows a diffusely edematous gastric wall compatible with phlegmonous gastritis and biopsy-induced mucosal erosion.

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  Fig. 2 Endoscopic treatment for early gastric cancer. (A) Endoscopy (9 days after admission) shows diffusely edematous mucosa and whitish purulent discharge at precutting for endoscopic submucosal dissection. (B) Argon plasma coagulation for treatment of early gastric cancer.

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  Fig. 3 Endoscopic findings after argon plasma coagulation (APC). (A) Endoscopy 3 months after APC shows resolution of edematous gastric mucosa and purulent discharge, with APC scars. (B) Endoscopy 6 months after initial APC shows recurrent adenocarcinoma at the previous APC site, and APC was repeated. (C) Endoscopy 24 months after initial APC shows recurrent early gastric cancer at the previous APC site.

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