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Diagnosis and treatment of acute phlegmonous gastritis: A case report
Hongxin Yang1, Zhiqiang Yan, Jiaju Chen
1Gastrointestinal Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China.
Rationale:
Acute phlegmonous gastritis (PG) is a rare and often fatal condition mainly characterized by severe bacterial infection of the gastric wall. Case reports of PG over the past century average about 1 per year. Early diagnosis and immediate treatment are crucial to achieve positive outcomes.
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. Physical examination revealed epigastric abdominal pain, rebound pain, and abdominal wall tightness. Abdominal CT showed thickening of the stomach wall with edema and gas.
Diagnoses:
On the basis of symptoms and CT imaging findings, the patient was diagnosed with acute PG.
Interventions:
Antibiotic therapy and operation.
Outcomes:
The patient immediately underwent an operation after conservative treatment using antibiotics proved ineffective. The whole stomach was obviously swollen, and the anterior side and posterior wall of the stomach were nigrescent necrotic. Hence, total gastrectomy was performed followed by reconstruction (roux-en-y), and pus that accumulated in the stomach wall was cultured. At postoperative broad-spectrum antibiotic coverage, the patient finally recovered.
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.
Insights
Phlegmonous gastritis (PG) is a rare, severe gastric infection. Prompt diagnosis and surgical intervention are critical for patient survival and recovery from this aggressive condition.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Phlegmonous gastritis (PG) is a rare, potentially fatal condition involving severe bacterial infection of the gastric wall.
- Historically, PG has an incidence of approximately one case per year, underscoring its rarity.
- Timely diagnosis and intervention are paramount for improving patient outcomes.
Observation:
- A 47-year-old male presented with acute abdominal pain, high fever, and vomiting.
- Clinical examination revealed epigastric tenderness with rebound pain and abdominal rigidity.
- Abdominal CT demonstrated gastric wall thickening with edema and gas, indicative of acute PG.
Findings:
- The patient underwent surgical intervention after conservative antibiotic therapy failed.
- Intraoperative findings included a swollen stomach with nigrescent necrosis of the anterior and posterior walls.
- A total gastrectomy with Roux-en-Y reconstruction was performed, and gastric pus was cultured.
Implications:
- Despite initial antibiotic treatment failure, the patient recovered following surgical management and broad-spectrum antibiotics.
- This case highlights the critical importance of early recognition and aggressive management, including surgery, for acute phlegmonous gastritis.
- Effective treatment strategies for PG necessitate a combination of prompt diagnosis, surgical intervention, and appropriate antibiotic therapy.
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