Diffuse phlegmonous gastroenterocolitis in a patient with an infected peritoneo-jugular venous shunt

Phlegmonous gastritis and enterocolitis have been observed in association with alcoholism and hepatic cirrhosis. We report a case of diffuse phlegmonous gastroenterocolitis that occurred 1 yr after the insertion of a peritoneojugular venous shunt (Denver type) in a young male heroin abuser with postnecrotic cirrhosis. Diplococcus pneumoniae was cultured from the occluded distal tip of the shunt and the organism was visualized throughout the inflamed submucosa of the entire gastrointestinal tract. The diagnosis of this condition was not made premortem and the case highlights some of the clinical manifestations of this gastrointestinal disease. The possible pathogenetic mechanisms involved in this inflammatory process are discussed.