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Phlegmonous Gastritis


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].

Fever
  • PG patients typically present with acute abdominal pain, vomiting and fever.[symptoma.com]
  • A case of acute diffuse phlegmonous gastritis in a 54 year old man with an abrupt onset of upper abdominal pain, high fever and complete anorexia was presented. The stomach wall was remarkably thickened and rigid.[ncbi.nlm.nih.gov]
  • 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]
  • We report a case of phlegmonous gastritis in a 36-year-old man presenting with anorexia, epigastralgia, and high fever. Endoscopy showed an edematous lesion suggesting a submucosal lesion.[ncbi.nlm.nih.gov]
  • 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]
Splenectomy
  • Here, we report the case of a 65-year-old male patient with a history of splenectomy, who had phlegmonous gastritis after esophagectomy.[ncbi.nlm.nih.gov]
  • At emergency operation, a total gastrectomy with splenectomy was performed. The most important differential diagnosis is carcinoma, especially scirrhous-type gastric cancer.[ncbi.nlm.nih.gov]
  • It was noted that this patient had a history of splenectomy 18 mo before esophagectomy, although there is no known relationship between PG and splenectomy, decreased immunity due to splenectomy combined with the post-surgical stress response may have[wjgnet.com]
Vomiting
  • 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]
  • PG patients typically present with acute abdominal pain, vomiting and fever.[symptoma.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]
  • The most important symptom is the intensive epigastric pain associated with vomits and most cases were diagnosed by CT and/or fibrogastroscopy.[ncbi.nlm.nih.gov]
  • PATIENT CONCERNS: A 47-year-old man was referred to our hospital because of abdominal pain, high fever, and vomiting for 4 days, with aggravation for 24 hours.[ncbi.nlm.nih.gov]
Nausea
  • A 64-year-old man presented with epigastralgia and nausea after an acute exacerbation of chronic pancreatitis. Abdominal computed tomography revealed remarkable thickening of the gastric wall and intramural hypodense areas.[ncbi.nlm.nih.gov]
  • 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]
  • 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.[symptoma.com]
  • We had experienced a case of 66-year-old man presented with epigastric pain , nausea , vomiting , and hematemesis , followed by aspiration pneumonia .[pesquisa.bvsalud.org]
  • Risk factors increasing age diabetes mellitus immunosuppression excessive proton pump inhibitor use iatrogenic: forceful procedures including upper GI endoscopy and nasogastric tube insertion 2 Upper central abdominal pain (maybe severe), nausea, hematemesis[radiopaedia.org]
Epigastric Pain
  • 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]
  • The most important symptom is the intensive epigastric pain associated with vomits and most cases were diagnosed by CT and/or fibrogastroscopy.[ncbi.nlm.nih.gov]
  • 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.[symptoma.com]
  • We had experienced a case of 66-year-old man presented with epigastric pain , nausea , vomiting , and hematemesis , followed by aspiration pneumonia .[pesquisa.bvsalud.org]
  • We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia.[synapse.koreamed.org]
Gastropathy
  • Gastropathy Chemical (reactive) gastropathy Chemical gastropathy was recommended as the preferred term to synonyms such as chemical gastritis, type C gastritis and reactive gastropathy, and refers to endoscopic and histological changes caused by chemical[cmej.org.za]
  • Emphysematous Gastritis Clinical Case Conference Ranjeeta Bahirwani August 25, ppt download Imaging of Abnormal Air in the Abdomen and Pelvis 20 Emphysematous Gastritis Radiopedia Pictures and Ideas on Meta Digestive System - Emphysema Gastritis and Gastropathies[e.hes.fr]
  • Reactive gastropathy is the second most common diagnosis made on gastric biopsy specimens after H pylori gastritis. This entity is believed to be secondary to bile reflux and was originally reported after partial gastrectomy (Billroth I or II).[emedicine.medscape.com]
  • Reactive gastropathy has a large number of causes, including: Gastritis; Additional images. Bile is a fluid produced by the liver to remove toxic substances, Erosive gastritis Reader Interactions[banksuenden.eu]
Loss of Appetite
  • 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]
  • 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]
  • The most common symptoms of acute gastritis include abdominal bloating, belching, loss of appetite, vomiting, nausea and nondescript epigastric discomfort. Some cases of acute gastritis may also be accompanied by painful sensations in the abdomen.[ic.steadyhealth.com]
  • Loss of appetite; increased thirst; Lethargy ; Prolonged vomiting; Severe diarrhea; Orange urine and an increased frequency of urination; Behavioral change such as what is the cure for cold sores natural remedies. gastritis drug therapy cider vinegar[ict-accordance.eu]
  • Common symptoms of gastritis: pain in the upper abdomen, fasting and / or after a meal, heaviness in the stomach after a meal, nausea, vomiting, regurgitation, weight loss, loss of appetite.[medicforums.blogspot.com]
Furunculosis
  • […] might be associated with alcohol consumption, chronic gastritis, trauma, and taking chemicals, drugs, and toxins. 2, 9, 15 Gastric ulcer or cancer is also associated with PG in several cases. 2 Septicemia related with bacterial endocarditis, erysipelas, furunculosis[ncbi.nlm.nih.gov]

Workup

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

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].

Pericardial Effusion
Air Bronchogram
  • bronchograms of the left lung, pleural and pericardial effusions were also suggested.[wjgnet.com]
Listeria Monocytogenes
  • We report what we believe to be the first case of phlegmonous gastritis due to Listeria monocytogenes.[scholars.northwestern.edu]
  • Phlegmonous gastritis: a previously unknown complication of listeria monocytogenes infection. Infect Dis Clin Pract 2016;24:17–9.[journals.lww.com]
Human Herpesvirus 8
  • Kaposi sarcoma is a low-grade vascular neoplasm associated with human herpesvirus 8, also known as the KS-associated herpesvirus. There are 4 epidemiologic types of KS.[archivesofpathology.org]
Corynebacterium Diphtheriae
  • It is most often caused by hemolytic group A streptococcus ( S pyogenes )2; however, it can also be caused by Staphylococcus, Pneumococcus, Enterobacter, and Actinomyces species, as well as by Escherichia coli, Corynebacterium diphtheriae, or gas-forming[archivesofpathology.org]
Gastric Lesion
  • Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection. Surg Endosc 2013;27:1211–1218. Min SY, Kim YH, Park WS.[jgc-online.org]
Multiple Ulcerations
  • (C) Esophagogastroduodenoscopy showed edematous, reddish mucosal changes, and multiple ulcerative lesions on the greater curvature of the stomach. Diffuse ulcerative lesions on the fundus of the stomach were also detected.[kjim.org]

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]
  • LESSONS: Acute PG is a rare infection of the gastric wall especially after antibiotic treatment. Given the fast progression of this disease, early recognition and immediate action are crucial to achieve positive outcomes.[ncbi.nlm.nih.gov]
  • Prompt diagnosis and treatment may improve the prognosis of this often lethal disease.[ncbi.nlm.nih.gov]
  • The global mortality is 27 % without identifying significant differences between antibiotics and surgical treatment, for that reason it is recommended to initiate antibiotic treatment right from the beginning and postponing surgery for the refractory[ncbi.nlm.nih.gov]
  • In our paper we are describing the case of a 66-year old female patient, who had received many years of treatment for rheumatoid arthritis. She died due to phlegmonous gastritis, which was only established post-mortem.[ncbi.nlm.nih.gov]

Prognosis

  • Prompt diagnosis and treatment may improve the prognosis of this often lethal disease.[ncbi.nlm.nih.gov]
  • 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]
  • Prompt diagnosis and treatment may improve the prognosis of this often lethal disease. From This Paper Figures, tables, and topics from this paper. Citations Publications citing this paper. References Publications referenced by this paper.[semanticscholar.org]
  • Treatment and prognosis Phlegmonous gastritis therapy requires aggressive supportive care with powerful antimicrobial agents. Occasionally surgery is required. Promoted articles (advertising)[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]
  • 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]
  • Gastric ischemia or a malignancy, were considered as etiology of the gastritis. H2-blocker and antibiotic therapy with cefuroxime and metronidazole were administered.[academic.oup.com]
  • Abdominal computed axial tomography (CAT) scan ( fig. 1 ) interpretation stated «important thickening of the gastric wall and duodenum of not-yet-determined etiology, reactive morphology of retroperitoneal and mesenteric lymph nodes, and pancreatic atrophy[revistagastroenterologiamexico.org]

Epidemiology

  • 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]
  • Epidemiology of infection. In: Mobley HLT, Mendz GL, Hazell SL, eds. Helicobacter pylori: Physiology and Genetics.Washington DC: ASM Press, 2001. Odze RD, Goldblum JR, eds.[cmej.org.za]
Sex distribution
Age distribution

Pathophysiology

  • […] 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]
  • 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 pathophysiological process is chiefly caused by the bacteria's invasion of the submucosa, propagating and diffusing into the mucosa and serous membrane, and is classified into diffuse and localized types according to the lesion range. [10,11] The[journals.lww.com]

Prevention

  • 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]
  • Dry skin Comprehensive overview covers causes risk factors treatment and prevention. These foods also be included in your diet.[fcemprague2016.eu]
  • […] other works by this author on: Hans K S Nuytinck, Department of Gastroenterology and Hepatology, Amphia Hospital Breda, Breda, the Netherlands Search for other works by this author on: Marianne J van Heerde, Department of Microbiology and Infection Prevention[academic.oup.com]
  • Simultaneously, the patient is given analgesics and is treated to prevent acute circulatory collapse (which often happens in such cases).[ahealthgroup.com]

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

Article

  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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Last updated: 2019-07-11 21:03