Acute phlegmonous gastritis complicated by delayed perforation.
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.
Sun Young Min, Yong Ho Kim, Won Seo Park, Department of Surgery, Kyung Hee University School of Medicine, Seoul 130-701, South Korea.
Sun Young
SY
Min
Sun Young Min, Yong Ho Kim, Won Seo Park, Department of Surgery, Kyung Hee University School of Medicine, Seoul 130-701, South Korea.
Yong Ho
YH
Kim
Sun Young Min, Yong Ho Kim, Won Seo Park, Department of Surgery, Kyung Hee University School of Medicine, Seoul 130-701, South Korea.
Won Seo
WS
Park
D015746:Abdominal Pain; D016145:Endoscopy, Digestive System; D005260:Female; D005743:Gastrectomy; D005756:Gastritis / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications*; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000601:surgery; D012772:Shock, Septic / Q000175:diagnosis; D013270:Stomach / Q000000981:diagnostic imaging; D013297:Streptococcus pyogenes; D014057:Tomography, X-Ray Computed
Gastric perforation; Phlegmonous gastritis; Streptococcus pyogenes