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Phlegmonous Gastritis
Inflammation of the Stomach with Severe Bacterial Invasion of the Gastric Wall

Presentation

PG patients typically present with acute abdominal pain, vomiting and fever. But although this symptom triad is considered characteristic of PG [4], retrospective studies have shown that considerable shares of patients don't experience any complaints besides an acute abdomen. In detail, epigastric pain has been reported in 95% of cases, whereas nausea, vomiting and fever are described by two thirds of affected individuals only [1]. A certain relief of pain may be achieved by changing from a supine to a sitting position (Deininger's sign) [5], and fever may be accompanied by chills. Patients less commonly present hematemesis or coffee-ground emesis [6]. Moreover, purulent emesis has been reported and is considered pathognomonic for PG [7].

Upon perforation, patients deteriorate rapidly and develop signs of diffuse peritonitis, sepsis and multiple organ failure [8]. There is one case report describing the discharge of pus to liver and spleen, giving rise to multiple hepatic and splenic abscesses [9].

Entire Body System

  • Fever

    On day 10, the patient developed neutropenic fever, and the white blood count (WBC) noted to be <0.1 × 109/L with absolute neutrophil count (ANC) of 0. [hindawi.com]

    PG patients typically present with acute abdominal pain, vomiting and fever. [symptoma.com]

    A 63-year-old woman was admitted with high fever. Laboratory tests showed leukocytosis and elevated C-reactive protein (CRP) levels. Abdominal ultrasonography and computed tomography revealed multiple liver and splenic tumors. [ncbi.nlm.nih.gov]

  • Malnutrition

    There are varying local and systemic associations like gastric ulcer, gastric carcinoma, post-therapeutic endoscopy, postsurgery, human immunodeficiency virus infection, malnutrition, Kaposi's sarcoma, myeloma, leukemia, Sjogren's syndrome, and glucocorticoid [ncbi.nlm.nih.gov]

    Some of the risk factors for presenting with phlegmonous gastritis are: immunodeficiencies, gastric carcinoma, prior therapeutic endoscopic procedure, oncologic diseases, malnutrition, and the chronic use of glucocorticoids. 4 However, approximately 50% [gastromexico.elsevier.es]

  • Pallor

    Objectively: pallor of integuments, hypotonia Temperature is often increased. Language is laid over. Morbidity at a palpation in epigastriums. [infomeds.net]

    Acute exogenous simple gastritis is characterized by nausea, vomiting of undigested food with mucus, sometimes bile, a feeling of fullness in the epigastrium, often pain syndrome, unpleasant taste in the mouth, general weakness; pallor of the skin, tongue [en.medicine-guidebook.com]

    When the patient arrived at the emergency department, he presented a general deterioration, pallor mucocutaneous and profuse sweating. [scielo.isciii.es]

    […] medical attention immediately if the following symptoms are experienced: Vomiting that makes intake of fluids, food and medicines impossible Unconsciousness or feeling that you may pass out\ Fever with abdominal pain Increased heartbeat (tachycardia) Pallor [myhealthbynature.com]

Respiratoric

  • Dyspnea

    Nil CT, EGD Antibiotics Nil Discharge Flor-de‐Lima F, 2015 M 7 Acute tonsillitis Epigastric pain, nausea, vomiting Streptococcus pneumoniae, EBV CT, EGD with biopsy Antibiotics Nil Discharge Guo et al., 2009 [3] M 57 CML, myeloid sarcoma Dyspnea, chest [hindawi.com]

    We have experienced a patient complaining of dyspnea due to right massive collection of hemorrhagic pleural fluid, who was strongly suspected of pancreatic hydrothorax from the elevated amylase level in the pleural fluid. [jlc.jst.go.jp]

    The next morning, the high temperature continued and the patient suddenly developed dyspnea with SaO 2 continuously below 90% after oxygen via a face mask (5 L/min). [wjgnet.com]

  • Pleural Effusion

    Postoperative complications included pleural effusion, bacteremia, pneumonia, and respiratory failure. Cultures from bronchoalveolar lavage grew methicillin-resistant Staphylococcus aureus and Escherichia coli. [archivesofpathology.org]

    EGD Antibiotics, surgery (not gastrectomy) Bilateral pleural effusions Discharge Kim et al., 2016 [2] M 74 Alcoholic cirrhosis, DM, recent EGD, gastric adenocarcinoma Abdominal pain, vomiting Nil CT, EGD with biopsy Antibiotics Nil Discharge Kim NY, 2011 [hindawi.com]

Gastrointestinal

  • Vomiting

    M 66 None Epigastric pain, nausea, vomiting Klebsiella, Acinetobacter CT, EGD with biopsy Antibiotics Nil Discharge Liu YJ, 2013 M 84 Colon cancer, prostate cancer Fever, nausea, vomiting Polymicrobial (gram positive and gram negative organisms) CT, [hindawi.com]

    Four days prior, the patient complained of severe epigastric pain with high fever (highest temperature was 39.2 °C) and vomited. [journals.lww.com]

  • Nausea

    Antibiotics, gastrectomy Nil Discharge Matsumoto H, 2015 M 74 Myelofibrosis, multiple myeloma, neutropenia Epigastric pain, nausea Bacillus spp. [hindawi.com]

    A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. [ncbi.nlm.nih.gov]

    It usually presents with upper gastrointestinal symptoms, such as nausea, vomiting, and hematemesis, along with systemic symptoms, including fever, chills, and fatigue. [cureus.com]

    Kim and Kim: Phlegmonous gastritis in an ankylosing spondylitis patient treated with infliximab A 51-year old man, with a 2-year history of ankylosing spondylitis (AS), was hospitalized for severe nausea and vomiting. [kjim.org]

  • Epigastric Pain

    Park CW, 2010 F 73 Gastric outlet narrowing Epigastric pain, abdominal distension E. coli, Acinetobacter CT, EGD with biopsy Antibiotics, pyloric stent Nil Discharge Rada-Palomino et al., 2014 [8] M 62 HIV Epigastric pain, hematemesis, diarrhea Streptococcus [hindawi.com]

    Phlegmonous gastritis is an acute inflammatory process of the stomach clinically characterized by acute localized noncolicky epigastric pain, purulent vomiting, fever, and leukocytosis. [ncbi.nlm.nih.gov]

    It presents with epigastric pain and vomiting. Other symptoms include fevers, chills, diarrhea, and hematemesis [4]. The diagnosis can be made using abdominal ultrasound, CT scan, endoscopy, and endoscopic ultrasound. [cureus.com]

    Superficial palpation produced epigastric pain and no organomegaly. [gastromexico.elsevier.es]

  • Acute Abdomen

    We report a case of phlegmonous gastritis associated with Kaposi sarcoma in a 37-year-old, human immunodeficiency virus (HIV)-positive man who presented with an acute abdomen. [ncbi.nlm.nih.gov]

    "acute phlegmonous gastritis"怎么读 相关词汇 phlegmonous appendicitis 中文, chronic superficial antral gastritis 中文, acute acute 中文, acute mumps 中文, acute hypoventilation 中文, acute abdomen 中文, acute bronchiolitis 中文, acute gonorrhea 中文, acute dyspnes 中文, acute [ichacha.net]

    Phlegmonous gastritis: a rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review. [academic.oup.com]

    In the case we described, the patient was asymptomatic and with unknown HIV status until he presented with an acute abdomen due to phlegmonous gastritis diagnosed after partial gastrectomy. This was associated with a nodule of KS. [archivesofpathology.org]

    But although this symptom triad is considered characteristic of PG, retrospective studies have shown that considerable shares of patients don't experience any complaints besides an acute abdomen. [symptoma.com]

  • Severe Abdominal Pain

    A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. [ncbi.nlm.nih.gov]

    We treated a patient with a high fever who complained of severe abdominal pain after ESD. Abdominal computed tomography (CT) revealed a diffuse, submucosal, minimally attenuated lesion and mucosal irregularity. [dbpia.co.kr]

    The authors report a case of a 59-year-old man who had severe abdominal pain with signs of peritonitis. [kci.go.kr]

    You should see a doctor if you have any of the following: Blood when you have a bowel movement Severe abdominal pain Heartburn not relieved by antacids Unintended weight loss Ongoing vomiting or diarrhea NIH: National Institute of Diabetes and Digestive [icdlist.com]

    Clinical symptoms are severe abdominal pain, inability to tolerate food, fever, and chills. 4,6 At present, treatment ranging from antibiotic therapy to gastric resection is controversial. 3,4 A 35-year-old man had a past history of non-atrophic gastritis [gastromexico.elsevier.es]

Cardiovascular

  • Thrombosis

    This shows an infiltration of polymorphonuclear leukocytes with foci of necrosis, thrombosis, and hemorrhage. The mucosa and muscularis propria are affected to a lesser degree. [archivesofpathology.org]

    Staphlyococci, pneumococci, Bacteroides coli, Bacteroides subtilis are also found.2,23 Usual pathologic findings are thickened submucosa due to infiltration by neutrophils and plasma cells.3 In advanced cases, there were intramural hemorrhage, necrosis, or thrombosis [ncbi.nlm.nih.gov]

  • Tachycardia

    Physical examination revealed diaphoresis, tachycardia, low-grade fever, and normal blood pressure. Superficial palpation produced epigastric pain and no organomegaly. [gastromexico.elsevier.es]

    Starr has proposed the criteria concerning chronic case as follows: 1) History reveals a prolonged illness of more than a few week's duration without rapid or sudden progression of symptoms and 2) minimal or no fever, tachycardia or leukocytosis. [webview.isho.jp]

Skin

  • Sweating

    There may be systemic signs of infection, such as fever, general fatigue, chills, sweating, headache, loss of appetite. Cause [ edit ] Commonly caused by bacterial infection, as in the case of cellulitis or diverticulitis. [en.wikipedia.org]

    Do you ever wake up drenched in sweat in the middle of the nighteven if the thermostat is turned low? Try these diabetes-friendly ways to prevent night itchy foot heart attack lower abdomen bloating pregnancy sweats. Bloating stomach after eating. [magyarregula.eu]

    […] pushed forward by fat weight loss is crucial Gastro Esophageal Reflux Disease (GERD) but occasionally a “referred” burning is felt in the back between the shoulder blades or in chest pain caused by Fatigue Pale Complexion Rapid Breathing Rapid Heart Beat Sweating [banksuenden.eu]

    There sweating, dizziness. headache, Fever, low blood pressure, tachycardia. [medicforums.blogspot.com]

    When the patient arrived at the emergency department, he presented a general deterioration, pallor mucocutaneous and profuse sweating. [scielo.isciii.es]

Workup

Laboratory analyses of blood samples should be conducted to assess the patient's general condition and typically yield the following results [5]:

  • Moderate to severe leukocytosis
  • Increased erythrocyte sedimentation rate
  • Elevation of C-reactive protein
  • Unaltered levels of amylase and lipase (contrary to patients suffering from acute pancreatitis)

Such results are non-specific, though, and it is necessary to perform diagnostic imaging in order to correlate the clinical picture with severe gastritis. Endoscopy is very helpful to this end, but computed tomography scans may also be carried out. During an endoscopic examination, multiple lesions of the gastric mucosa may be observed. In general, they are largely covered by mucopurulent exudate and are prone to bleed. Generalized edema and erythema are also seen. Endosonography may allow for a better examination of deeper layers of the gastric wall. In this context, hypoechoic lesions in the submucosal layer have been described [1]. Images obtained by means of computed tomography typically show marked thickening of the gastric wall and intramural hypodense regions [10].

Serum

  • Hypochlorhydria

    The symptoms of low stomach acid (a condition known as hypochlorhydria) closely mimic Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins Handbook Staphylococcus aureus. Diets by themselves will not cause or cure ulcers. [banksuenden.eu]

    Download Break It Down and Make It Plain: Proclaiming Freedom to Hypochlorhydria aka l ow stomach acid is a commonly overlooked and sometimes serious problem that most people aren’t aware they have. [magyarregula.eu]

    Destruction of the cells producing hydrochloric acid and intrinsic factor, respectively, results in hypochlorhydria and a reduction in pepsin activity within gastric juices and may lead to pernicious or iron deficiency anemia. [cmej.org.za]

    AMAG is the pathologic process in patients with pernicious anemia, an autoimmune disorder usually occurring in patients of northern European or Scandinavian background. 33 Patients with AMAG exhibit achlorhydria or hypochlorhydria, hypergastrinemia secondary [clinicalgate.com]

Gastroscopy

  • Gastric Lesion

    Endoscopic submucosal dissection (ESD) is widely used to treat a variety of gastric lesions including early gastric cancer and gastric adenoma. Bleeding and perforation are the most common complications of ESD. [dbpia.co.kr]

Pleura

  • Pleural Effusion

    Postoperative complications included pleural effusion, bacteremia, pneumonia, and respiratory failure. Cultures from bronchoalveolar lavage grew methicillin-resistant Staphylococcus aureus and Escherichia coli. [archivesofpathology.org]

    EGD Antibiotics, surgery (not gastrectomy) Bilateral pleural effusions Discharge Kim et al., 2016 [2] M 74 Alcoholic cirrhosis, DM, recent EGD, gastric adenocarcinoma Abdominal pain, vomiting Nil CT, EGD with biopsy Antibiotics Nil Discharge Kim NY, 2011 [hindawi.com]

Treatment

The patient was given empirical antibiotic treatment, and the white blood cell decreased dramatically. Surgical intervention was discussed but deferred. Despite continued antibiotics treatment, the patient died. [ncbi.nlm.nih.gov]

Acute PG has an extremely high mortality rate, and the key to successful treatment is early diagnosis and treatment. [journals.lww.com]

Prognosis

Phlegmonous gastritis is an unusual infection of the gastric wall, which is extremely rare and associated with a poor prognosis. [ncbi.nlm.nih.gov]

Prognosis: —The prognosis is always unfavorable. Usually death results within a few days. In an occasional case the symptoms may be milder, but there is chilliness, with erratic temperature, increasing prostration and ultimate death. [henriettes-herb.com]

Prognosis In most cases prognosis for acute gastritis is good if the stomach was cleansed in time and the right treatment was prescribed. [ahealthgroup.com]

Treatment and prognosis Phlegmonous gastritis therapy requires aggressive supportive care with powerful antimicrobial agents. Occasionally surgery might be required. There is risk of developing peritonitis is 70% of cases. [radiopaedia.org]

Etiology

The etiology remains unclear, although Streptococcus species is isolated frequently. The optimum treatment has not been delineated clearly but likely involves a combination of antibiotics with or without surgical resection. [ncbi.nlm.nih.gov]

Depends on the etiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Etiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDS autoimmune caustic ingestion [radiopaedia.org]

Etiology: —The disease appears at all ages of adult life, very rarely as a primary disorder. Usually it follows as a sequel to acute infectious fevers, notably those strictly designated as septic fevers. [henriettes-herb.com]

Epidemiology

Otorhinolaryngology (26) Medical Chemistry and Biochemistry (24) Dermatology (17) Cardiology, Angiology (15) Dentistry (15) Endocrinology, Metabolism (14) Immunology, Allergology (13) Respiratory Medicine (13) Diabetology, Dietetics (12) Obstetrics, Gynaecology (11) Epidemiology [portal.mefanet.cz]

Updated content prepares you for today's practice with the latest on morbidity, mortality, and epidemiology; invasive squamous cell carcinoma; scoliosis; joint replacements; chest tubes and lines; MRSA (antibiotic-resistant staph infection); systemic [books.google.de]

There are 4 epidemiologic types of KS. Classic KS is an indolent cutaneous form mainly found on lower extremities and affecting older men of Mediterranean and Jewish origin. [archivesofpathology.org]

[…] conventional thinking was that no bacterium could live in the acid environment of the La gastritis puede ser aguda es decir de inicio reciente o crnica. knowledge & awareness; causes of injury; road safety behaviours; Software Configuration Management Epidemiology [banksuenden.eu]

The clinical epidemiology of GERD is related to diet. It has been speculated that certain dietary factors may play a role in the pathogenesis or course of GERD. [search.koreanstudies.net]

Pathophysiology

Am Surg. 1970; 36: 225-231 Weinstein WM Other types of gastritis and gastrophathies, including Menetrier's Disease. in: Sleisenger MH Fordtran JS Gastrointestinal and liver disease: pathophysiology/diagnosis/management. [clinicalimaging.org]

[…] speculated that patients with a medical history of recurrent gastritis, those suffering from chronic ulcer that may or may not be the result of drug abuse, as well as immunocompromised individuals are at higher risks of developing PG, but the disease' pathophysiology [symptoma.com]

Pathology and Forensic Medicine (84) Internal Medicine (72) Paediatrics, Neonatology (71) Infectology (46) Surgery, Traumatology and Orthopaedics (35) Physiology and Pathophysiology (35) Microbiology (32) Neurology (31) Gastroenterology and Hepatology [portal.mefanet.cz]

Pathophysiology There are a large number of different causes of acute gastritis but the most common ones include direct trauma, food poisoning, allergies, radiation, shock, acute stress, fungal infections, viral infections, bacterial infections, ischemia [ic.steadyhealth.com]

The pathophysiology of PG is not fully understood. Patients present with abdominal pain, nausea, vomiting, and fever. [cureus.com]

Prevention

Several randomized clinical trials have demonstrated the efficacy of ICDs in the primary prevention of SCD. [search.koreanstudies.net]

A proton pump inhibitor and a steroid hormone were administered every day to prevent peptic ulcer formation and secondary adrenal insufficiency. [jstage.jst.go.jp]

Remedies that exercise a soothing influence upon the stomach should be used in conjunction with echinacea, baptisia and calcium sulphid, to prevent or retard the development of pus and to antagonize pyemia. [henriettes-herb.com]

Medical Chemistry and Biochemistry (24) Dermatology (17) Cardiology, Angiology (15) Dentistry (15) Endocrinology, Metabolism (14) Immunology, Allergology (13) Respiratory Medicine (13) Diabetology, Dietetics (12) Obstetrics, Gynaecology (11) Epidemiology, Preventive [portal.mefanet.cz]

Dry skin Comprehensive overview covers causes risk factors treatment and prevention. These foods also be included in your diet. [fcemprague2016.eu]

Summary

Phlegmonous gastritis (PG), sometimes also referred to as suppurative gastritis, is a rare type of stomach infection and inflammation. It is provoked by pyogenic bacteria, most commonly by pathogens of the genus Streptococcus [1], and is associated with high mortality [2]. It has been speculated that patients with a medical history of recurrent gastritis, those suffering from chronic ulcer that may or may not be the result of drug abuse, as well as immunocompromised individuals are at higher risks of developing PG [3], but the disease' pathophysiology remains poorly understood. About half of PG patients have no medical history of stomach disease. PG may be restricted to determined parts of the stomach lining, or may affect the whole stomach. Accordingly, localized and diffuse PG may be distinguished. Successful treatment regimens comprise the administration of antibiotics and surgery. Because survival rates are similar in either case, most patients are initially prescribed antibiotics and surgical interventions are postponed for refractory cases and complications [2]. If necessary, partial or complete gastrectomy may be performed.

References

  1. Kim GY, Ward J, Henessey B, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc. 2005; 61(1):168-174.
  2. Rada-Palomino A, Muñoz-Duyos A, Pérez-Romero N, et al. Phlegmonous gastritis: A rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review. Rev Esp Enferm Dig. 2014; 106(6):418-424.
  3. Kavalar R, Skok P, Kramberger KG. Phlegmonous gastritis in a patient with rheumatoid arthritis. Wien Klin Wochenschr. 2005; 117(9-10):364-368.
  4. Orel R, Mlinaric V, Stepec S, Luzar B, Brencic E, Cerar A. Acute phlegmonous gastritis associated with Helicobacter heilmannii infection in a child. Dig Dis Sci. 2006; 51(12):2322-2325.
  5. Alonso JV, de la Fuente Carillo JJ, Gutierrez Solis MA, Vara Morate FJ, Lopez Ruiz DJ. Gastric wall abscess presenting as thoracic pain: rare presentation of an old disease. Ann Gastroenterol. 2013; 26(4):360-362.
  6. Jaballah S, Sabri Y, Yacoubi MT, Mustapha K. Phlegmonous gastritis complicated by upper digestive hemorrhage. Dig Dis Sci. 1999; 44(12):2435-2438.
  7. Nicholson BW, Maull KI, Scher LA. Phlegmonous gastritis: clinical presentation and surgical management. South Med J. 1980; 73(7):875-877.
  8. Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol. 2014; 20(12):3383-3387.
  9. Sakata T, Narita M, Ohtani N, et al. A case of phlegmonous gastritis with multiple liver and splenic abscesses. Nihon Shokakibyo Gakkai Zasshi. 2011; 108(1):50-58.
  10. Sood BP, Kalra N, Suri S. CT features of acute phlegmonous gastritis. Clin Imaging. 2000; 24(5):287-288.
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