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

Nha Young Kim; Ju Sang Park; Ki Jong Lee; Han Kyeol Yun; Ja Seon Kim

doi:10.4166/kjg.2011.57.5.309

Journal List > Korean J Gastroenterol > v.57(5) > 1006811

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Kim, Park, Lee, Yun, and Kim: A Case of Acute Phlegmonous Gastritis Causing Gastroparesis and Cured with Medical Treatment Alone

Case Report

Korean J Gastroenterol 2011;57(5):309-314.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.5.309

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

Nha Young Kim, Ju Sang Park, Ki Jong Lee, Han Kyeol Yun, Ja Seon Kim

Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea

Correspondence to: Ju Sang Park, Department of Internal Medicine, Bundang Jesaeng General Hospital, 255-2, Seohyun-dong, Bundang-gu, Seongnam 463-774, Korea. Tel: +82-31-779-0209, Fax: +82-31-779-0897, E-mail: parkjs@dmc.or.kr

Received 25 February 201016 April 2010 Accepted 20 April 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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-en-hanced 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.

Keywords: Phlegmonous gastritis, Anti-bacterial agent, Gastroparesis

References

1. Miller AI, Smith B, Rogers AI. Phlegmonous gastritis. Gastroenterology. 1975; 68:231–238.

2. Wakayama T, Watanabe H, Ishizaki Y, et al. A case of phlegmonous esophagitis associated with diffuse phlegmonous gastritis. Am J Gastroenterol. 1994; 89:804–806.

3. Kim GY, Ward J, Henessey B, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc. 2005; 61:168–174.

4. Lee TH, Lee GS, Im EH, et al. A case of acute phlegmonous gastritis treated with antibiotics alone. Korean J Gastrointest Endosc. 2005; 31:44–48.

5. Choong NW, Levy MJ, Rajan E, Kolars JC. Intramural gastric abscess: case history and review. Gastrointest Endosc. 2003; 58:627–629.

6. Joko T, Tanaka H, Hirakata H, et al. Phlegmonous gastritis in a haemodialysis patient with secondary amyloidosis. Nephrol Dial Transplant. 1999; 14:196–198.

7. Radhi J, Kamouna M, Nyssen J. Phlegmonous gastritis following coronary bypass surgery. Can J Gastroenterol. 1999; 13:837–839.

8. Yu QQ, Tariq A, Unger SW, Cabello-Inchausti B, Robinson MJ. Phlegmonous gastritis associated with Kaposi sarcoma: a case report and review of the literature. Arch Pathol Lab Med. 2004; 128:801–803.

9. Lee BS, Kim SM, Seong JK, et al. Phlegmonous gastritis after endoscopic mucosal resection. Endoscopy. 2005; 37:490–493.

10. Min JS, Cho CH, Cho KS, et al. Diffuse phlegmonous gastritis. Korean J Gastroenterol. 1980; 12:73–77.

11. Choi KM, Kwon YJ, Park MG, et al. Two cases of acute phlegmonous gastritis. Korean J Gastrointest Endosc. 1995; 15:79–83.

12. Lee BK, Park KT, Kim ES, et al. A case of phlegmonous gastritis. Korean J Med. 1988; 34:421–425.

13. Lee GW, Lee OJ, Jung KW, et al. Acute phlegmonous gastritis diagnosed early endoscopically and treated successfully with antibiotics. Korean J Gastrointest Endosc. 2001; 23:225–229.

14. Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol. 2009; 15:25–37.

15. Kanno Y, Irisawa A, Takagi T, et al. Endosonographic diagnosis and follow-up of phlegmonous gastritis. J Clin Ultrasound. 2007; 35:524–526.

16. Iwakiri Y, Kabemura T, Yasuda D, et al. A case of acute phlegmonous gastritis successfully treated with antibiotics. J Clin Gastroenterol. 1999; 28:175–177.

17. Hu DC, McGrath KM, Jowell PS, Killenberg PG. Phlegmonous gastritis: successful treatment with antibiotics and resolution documented by EUS. Gastrointest Endosc. 2000; 52:793–795.

18. Kim HS, Jang WI, Lee SS, et al. Two cases of phlegmonous gastritis secondary to corrosive gastritis caused by formalin. Korean J Med. 1991; 40:268–273.

19. Jung JH, Choi HJ, Yoo J, Kang SJ, Lee KY. Emphysematous gastritis associated with invasive gastric mucormycosis: a case report. J Korean Med Sci. 2007; 22:923–927.

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 (T_1/2: 43.5 min). (B) Follow-up emptying time (26 days after admission) was normal (T_1/2: 13.5 min).

Table 1.

Review of 9 Cases of Phlegmonous Gastritis in Korean Literature⁴

Year	Age/sex	Symptoms	Associated conditions	Location	Microorganism	Treatment/ Hospital day ^b	Outcome
1980¹⁰	44/M	Chill, nausea, epigastric pain	Alcohol	Antrum	Klebsiella	Surgery/6 ^th	Death
1988¹²	34/M	Hematemesis	Nothing	Diffuse	Enterobacter, E. coli, M. morganii	Surgery/3 ^rd	Death
1991¹⁸	51/M	NA ^a	Formalin indigestion	Diffuse	E. coli	Surgery/47 ^th	Death
1991¹⁸	55/M	NA ^a	Formalin indigestion	Fundus	Pseudomonas aeruginosa	Antibiotics/1 ^st	Recovery
1995¹¹	61/F	Abdominal pain, nausea, fever	Hydrocephalus	Diffuse	E. faecalis, Klebsiella	Surgery/6 ^th	Recovery
1995¹¹	60/F	Vomiting	Nothing	Diffuse	E. faecalis, E. coli	Antibiotics/3 ^rd	Recovery
2001¹³	51/F	Fever, melena, abdominal pain	Alcohol	Corpus	Staphylococcus aureus	Antibiotics/1 ^st	Recovery
2005⁴	59/M	Abdominal pain, fever	Alcohol	Diffuse	E. faecalis	Antibiotics/1 ^st	Recovery
2005⁹	68/F	Abdominal pain, fever	Nothing	Diffuse	Enterococcus fecalis	Surgery/4 ^th	Recovery
2007¹⁹	43/M	Abdominal pain	Alcohol	Diffuse	Klebsiella	Surgery/1 ^st	Death
			Diabetes mellitus		Staphylococcus aureus
					Pseudomonas aeruginosa
Current case	66/M	Nausea, vomiting, hematemesis, abdominal pain	Diabetes mellitus	Diffuse	Klebsiella oxytoca, Acinetobacter lwoffii	Antibiotics/1 ^st	Recovery

M: male; F: female.

^a Not available.

^b The day when surgery was done or antibiotics was started.

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