Phlegmonous gastritis, also known as phlegmonitis of the stomach, is an uncommon, life-threatening condition which is due to diffuse infection of the submucosa of the stomach.
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Epidemiology
Although the gastric form is the commonest type of phlegmonitis seen in the gastrointestinal tract, it remains rare, with total published cases numbering just over 100 1. Mortality is high, with a death rate of 42% 1.
Risk factors
- increasing age
- diabetes mellitus
- immunosuppression
- gastric ulcers 3
- excessive proton pump inhibitor use
- iatrogenic: gastric surgery, forceful procedures including upper GI endoscopy and nasogastric tube insertion 2,3
- septicemia 3
Clinical presentation
Upper central abdominal pain (maybe severe), nausea, hematemesis and an abrupt pyrexia 2.
Pathology
Streptococcus spp. have been found to be the most common causative organisms, accounting for about two-third of cases 2.
There are two main forms of phlegmonous gastritis: diffuse or localized.
Diffuse involves the complete stomach, conversely localized disease most commonly is restricted to the antrum. It is unusual for the cardia or the pylorus to be involved 1,2.
Occasionally phlegmonitis of the esophagus coexists, in which case the condition is described as phlegmonous oesophagogastritis.
Radiographic features
CT
CT findings of phlegmonous gastritis include diffuse gastric mural thickening with intramural hypodensities, the latter representing submucosal abscesses contained within the wall 2.
Treatment and prognosis
Phlegmonous gastritis therapy requires aggressive supportive care with powerful antimicrobial agents. Occasionally surgery might be required.
There is risk of developing peritonitis is 70% of cases. A severely contracted stomach may result from healing 3.
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