Acute phlegmonous gastritis complicated by delayed perforation

Here,we report on a case of acute phlegmonous gastritis(PG)complicated by delayed perforation.A51-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.

Phlegmonous gastritis after esophagectomy:A case report

Phlegmonous gastritis is an unusual infection of the gastric wall,which is extremely rare and associated with a poor prognosis.Here,we report the case of a 65-year-old male patient with a history of splenectomy,who had phlegmonous gastritis after esophagectomy.Computed tomography revealed a remarkably distended thoracic stomach,and the gastric wall was locally thickened.Gastric mucosa was red and white in color and significantly edematous on gastroscopy.He was successfully treated with a combination of antibiotics and povidone-iodide intraluminal lavage.In addition to this case,the clinical presentations,imaging examinations as well as treatments of phlegmonous gastritis are discussed.

Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia:A case report

BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall.The most representative causative bacterium is Streptococcus pyogenes,followed by Staphylococcus,Pneumococcus and Enterococcus.Hepatic portal venous gas(HPVG)is considered a potentially fatal condition and is rarely associated with PG.CASE SUMMARY The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy.Her vital signs were consistent with septic shock.Venous blood culture revealed the presence of Bacillus cereus.Abdominal computed tomography(CT)and esophagogastroduodenoscopy(EGD)showed marked thickening of the gastric wall.As with the other findings,CT was suggestive of HPVG,and EGD showed pseudomembrane-like tissue covering the superficial mucosa.Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils.Culture of gastric specimens revealed the presence of Bacillus cereus.We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG.This patient recovered successfully with conservative treatment,chiefly by using carbapenem antibiotics.CONCLUSION The histopathological finding of this gastric biopsy specimen should be called"neutropenic necrotizing gastritis".

Phlegmonous gastritis after biloma drainage:A case report and review of the literature

BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infection of the gastric submucosa and is related to septicemia,direct gastric mucosal injury,or the direct influence of infection or inflammation in neighboring organs.Here,we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage.CASE SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d.Physical examination showed stable vital signs,icteric sclera,diffuse abdominal tenderness,and muscle guarding.Laboratory tests showed hyperbilirubinemia and bandemia.Contrast computed tomography(CT)of the abdomen showed a dilated common bile duct and left subphrenic abscess.Left subphrenic abscess drainage revealed bilious fluid,and infected biloma was confirmed.Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening.Esophagogastroduodenoscopy(EGD)showed an edematous,hyperemic gastric mucosa with poor distensibility.The gastric mucosal culture yielded Enterococcus faecalis.PG was diagnosed based on imaging,EGD findings,and gastric mucosal culture.The patient recovered successfully with antibiotic treatment.CONCLUSION PG should be considered in patients with intraabdominal infection,especially from infected organs adjacent to the stomach.

Fulminant phlegmonitis of the esophagus, stomach,and duodenum due to Bacillus thuringiensis

We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-virulence bacilli can cause lethal gastrointestinalphlegmonous gastritis in conditions of immunodeficiency.

Treatment options of inflammatory appendiceal masses in adults

At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient's own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn's disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.

What constitutes failure of medical therapy in the changing landscape of Crohn's disease?

The management of Crohn's disease has evolved rapidly in the era of immunomodulators and biologicals.Despite this,a significant proportion of patients with Crohn's disease ultimately require surgical management.One of the indications for operative management includes failure of medical therapy.We report two cases of patients with complicated Crohn's disease who have exhausted medical therapy and failed medical management.In both cases,the patients developed large complex intra-abdominal phlegmons and intractable symptoms of intermittent pain,partial obstruction and/or infectious complications requiring operative intervention.Crohn's disease can present with a wide spectrum of disease.Considering the complexity of management in Crohn's disease,it is important for both physicians and surgeons to be aware of what constitutes failure of medical therapy and when it may be important to consider surgical involvement.

Digital Dermatitis in Dairy Cattle Is Still a Serious Problem in Western Europe

Bacterial infections are quite common in dairy cattle,and frequently related to internal organ systems like e.g.respiratory,intestinal and udder infections.Lameness in dairy cattle is mainly caused by both infectious and non-infectious hoof problems and these have different etiological background.At the moment(2018)the major infectious hoof disorders are DD(Digital Dermatitis)and IP(Interdigital Phlegmon).These are all due to infection from the area where dairy cows normally live and more or less intensive contact with“contaminated”manure.This paper gives insight in these different dermatitis problems cows are daily confronted with,with a focus on infectious hoof disorders as a more or less permanent problem in today’s dairy farming.