title: Acute gastric necrosis after routine oesophagogastroduodenoscopy with therapeutic argon plasma coagulation.
abstract: A 56-year-old woman presented to the accident and emergency department with peritonitis 2 days after a routine oesophagogastroduodenoscopy. She was taken to theatre with the finding of gastric necrosis. Blood and peritoneal cultures grew group A haemolytic Streptococcus. Histology revealed normal vasculature, no volvulus but marked neutrophilia in the submucosa with an intact mucosa. The stomach was resected and the patient recovered in the intensive care unit but overwhelming acidosis progressed to multiorgan failure and treatment was eventually withdrawn. Acute phlegmonous gastritis has been well described in the literature but mainly before the advent of antibiotics. The most common organism is group A haemolytic Streptococcus (commonly found in throat infections) and predisposing factors include instrumentation. Should antibiotics be given at the start of an oesophagogastroduodenoscopy and should routine procedures be delayed if active upper respiratory tract infections are present?
authors.affiliation: Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK. ks303@doctors.org.uk.
authors.forename: K
authors.initials: K
authors.lastname: Sahnan
authors.forename: B J H
authors.initials: BJ
authors.lastname: Davis
authors.forename: J
authors.initials: J
authors.lastname: Bagenal
authors.forename: S
authors.initials: S
authors.lastname: Cullen
authors.forename: S
authors.initials: S
authors.lastname: Appleton
mesh_terms: D057908:Argon Plasma Coagulation / Q000009:adverse effects*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000601:surgery; D006801:Humans; D007108:Immune Tolerance; D007511:Ischemia / Q000382:microbiology; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D010538:Peritonitis / Q000209:etiology; D013270:Stomach / Q000098:blood supply / Q000473:pathology*; D013290:Streptococcal Infections / Q000209:etiology
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