An Under-Recognised Rapidly Fatal Condition: Phlegmonous Gastritis

Area of Science:

• Gastroenterology
• Infectious Diseases
• Surgical Pathology

Background:

• Phlegmonous gastritis is a rare infectious process affecting the gastric wall, often associated with hemolytic Streptococcus.
• Diagnosis is frequently delayed due to non-specific symptoms like abdominal pain, nausea, vomiting, and fever.
• Computed tomography (CT) typically shows gastric wall thickening, low-intensity areas, and gas accumulation.

Purpose of the Study:

• To present a clinical case of phlegmonous gastritis.
• To highlight the diagnostic challenges and the importance of early clinical suspicion.
• To emphasize the need for prompt treatment in severe cases.

Main Methods:

• Case report of a 58-year-old male with severe gastrointestinal symptoms and fever.
• Diagnostic workup included laboratory evaluation, abdominal CT scan, and upper gastrointestinal endoscopy.
• Treatment involved broad-spectrum antibiotics and urgent total gastrectomy.

Main Results:

• The patient presented with symptoms suggestive of severe infection, leading to septic shock.
• CT scan revealed significant gastric wall thickening and perigastric fat densification.
• Despite aggressive treatment including gastrectomy, the patient experienced multi-organ dysfunction and died.
• Histopathology confirmed phlegmonous gastritis.

Conclusions:

• Phlegmonous gastritis is a rare, potentially fatal infectious disease primarily affecting the stomach submucosa.
• CT imaging and gastroscopy are key diagnostic tools, though endoscopic findings can be non-specific.
• Early diagnosis and treatment, potentially including urgent surgery, are critical for improving prognosis, as conservative antibiotic therapy may be insufficient.