Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3383
Revised: December 31, 2013
Accepted: January 20, 2014
Published online: March 28, 2014
Processing time: 159 Days and 14.3 Hours
Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. 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. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient’s clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient’s condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.
Core tip: Acute phlegmonous gastritis (PG) is a rare and often fatal condition that is characterized by bacterial infection. Patients with PG can present with abdominal pain, abdominal distension, nausea, vomiting, fever, and signs of infection. Computed tomography is useful in the early diagnosis of PG. However, because of the rarity of this disease, the diagnosis and choice of appropriate treatment is difficult. Here, we report a case of acute PG complicated by delayed perforation during conservative treatment after explorative laparotomy without gastric resection.