Acute phlegmonous gastritis

Intramural Gastric Abscess Misdiagnosed as Advanced Gastric Cancer

An intramural gastric abscess is a rare condition often mistaken for other medical diseases such as gastric cancer and neoplasms. We present a case of a patient initially believed to have pancreatic cancer based on his computed tomography scan. The clinical diagnosis of locally advanced gastric cancer was made on subsequent magnetic resonance cholangiography and endoscopic ultrasound (EUS). However, several EUS-guided biopsies did not reveal malignant cells. A partial gastrectomy was performed for diagnostic and therapeutic purposes. The specimen showed only inflammatory cells, without any malignant cells. The final diagnosis was gastric wall abscess (GWA) that infiltrated and adhered to the adjacent tissues. This case reminds that physicians should include GWA as a differential diagnosis in the suspicion of gastric cancer. Although GWA is rare, it is often forgotten when focusing on the possibility of fatal cancer.

Gastric wall abscess: A case report and literature review

Background

gastric wall abscess is a rare pathology that is often hard to diagnose and is often associated with poor prognosis. Herein, we report a case of Gastric wall abscess that we managed to treat by endoscopy without the need for surgery which is the usual treatment of choice.

Clinical data

a 50 years old female presented with Epigastric pain. Complete blood count revealed Leukocytosis, neutrophilia and an elevated C-reactive protein. Abdominal CT scan showed a small hypodense area with rim wall enhancement in the pyloric canal. Gastroscopy and endoscopic ultrasound guided drainage was performed and the abscess was drained, content sent for pathology evaluation. Patient was discharged home on antibiotics.

Conclusion

Gastric wall abscess is a rare but important differential diagnosis of Epigastric pain. Endoscopic Ultrasound is the modality of choice to diagnose it. Endoscopic drainage is associated with reduced mortality and morbidity (Soga et al., 2014) [2].

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Gastric wall abscess is a rare pathology of gastric wall with vague presentations.

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Immune-compression, alcohol and diabetes are predisposing factors but some patient may have no such factors.

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The diagnosis of Gastric wall abscess is clinically challenging and it requires a high clinical suspicion.

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Theraputic endoscopic drainage is a promising method to treat it.

Anastomotic leakage with abscess after laparoscopic sleeve gastrectomy for obesity: report of a series and review of literature

Anastomotic leakage with abscess is a rare but severe complication of bariatric surgery. However, there is currently a lack of attention regarding this complication. This study aimed to investigate the risk factors for this complication and relevant treatment strategies to call attention to this severe complication. We retrospectively reviewed the patients who were rehospitalized for anastomotic leakage with abscess after bariatric surgeries in West China Hospital of Sichuan University from November 2017 to November 2018. The clinical profiles analyzed included body mass index, body weight before and after surgery, postoperative hospital stay, diet prescriptions, treatment strategies, and outcomes. A total of six patients (two men and four women) were included. The mean baseline body mass index was 37.52 (29.84–43.37), and the mean weight was 104.95 kg (74.5–127.5). The chief complaints leading to rehospitalization were fever and dull abdominal pain. The average postoperative hospital stay was 3.3 (3–4) days, and the onset time ranged from 7 to 15 days. Finally, revision surgeries were performed in two of the six patients (33%), and they were all cured by percutaneous drainage-based treatments. The postoperative fever and abdominal pain were the signs of leakage and abscess. Similar patients should be followed up once a week for 3 weeks after bariatric surgery to facilitate the early recognition of this complication. A longer hospital stay and sufficient parenteral nutrition plus a later implementation of diet should be helpful to minimize this severe complication. Percutaneous drainage played a significant role in the treatment of these patients.

Gastric subepithelial lesion complicated with abscess: Case report and literature review

Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high mortality as a result. In general, subepithelial lesions (SELs) of the stomach are incidentally detected during the course of upper endoscopy without specific clinical symptoms and signs. However, some gastric SELs present rarely as a form of hemorrhage, obstruction, perforation, and abscess. Here we report a 45-year-old man with gastric SEL presenting as a gastric abscess, which was diagnosed as an ectopic pancreas of the stomach, along with a review of the literature. Although gastric SEL presenting as an abscess is known as a serious and life-threatening lesion, the patient made a complete recovery through surgical resection as well as medical treatment.

Congenital and oral transmission of American trypanosomiasis: an overview of physiopathogenic aspects

Chagas disease or American trypanosomiasis is a pathology affecting about 8-11 million people in Mexico, Central America, and South America, more than 300 000 persons in the United States as well as an indeterminate number of people in other non-endemic countries such as USA, Spain, Canada and Switzerland. The aetiological agent is Trypanosoma cruzi, a protozoan transmitted by multiple routes; among them, congenital route emerges as one of the most important mechanisms of spreading Chagas disease worldwide even in non-endemic countries and the oral route as the responsible of multiple outbreaks of acute Chagas disease in regions where the vectorial route has been interrupted. The aim of this review is to illustrate the recent research and advances in host-pathogen interaction making a model of how the virulence factors of the parasite would interact with the physiology and immune system components of the placental barrier and gastrointestinal tract in order to establish a response against T. cruzi infection. This review also presents the epidemiological, clinical and diagnostic features of congenital and oral Chagas disease in order to update the reader about the emerging scenarios of Chagas disease transmission.

Gastric leiomyosarcoma presenting as a gastric wall abscess

Gastric abscess is a rare disorder with approximately 500 cases reported. Two variants are seen diffuse (Phlegemous) or localized. We report a spindle cell tumor (leiomyosarcoma) presenting as a localized gastric wall abscess.

Two cases of idiopathic acute gastric necrosis

Two cases of acute hemorrhagic gastric necrosis are presented. The first patient was a 62 yr old man with a past history of chronic gastritis, Parkinson's disease and dementia. The second case was a 25 yr old woman with recent abuse of oral analgesic agents. Both presented with an acute abdomen and peritonitis, and underwent urgent gastrectomy for gastric necrosis with perforation. The first patient died, whereas the second recovered. Histology of the gastrectomy specimens showed severe hemorrhagic transmural gastric necrosis with minimal inflammatory changes. Only occasional Gram positive rods were seen in case 1, and microbiological cultures were negative. The etiology of the gastric necrosis in these 2 cases is unclear.

Phlegmonous gastritis associated with HIV-1 seroconversion. Endoscopic and microscopic evolution

A 40-year-old man presented with peritonitis. Diagnosis of phlegmonous gastritis was made by laparotomy. Conservative treatment combined with antibiotics was successful. Multiple endoscopies with biopsies illustrate the natural history of this disease. The patient developed HIV-1 seroconversion during hospital stay. Prompt diagnosis and treatment may improve the prognosis of this often lethal disease.

Acute diffuse phlegmonous gastritis

A case of acute diffuse phlegmonous gastritis in a 54 year old man with an abrupt onset of upper abdominal pain, high fever and complete anorexia was presented. The stomach wall was remarkably thickened and rigid. Histologically there was massive infiltration of polymorphonuclear leukocytes in the submucosa and muscularis of the stomach wall. The lamina muscularis mucosae was fragmented by the numerous small focal abscesses.

Acute diffuse phlegmonous gastritis

Phlegmonous gastritis is a rare inflammatory disorder of the stomach and is thought to have first been described by Galen in 1600; its recognition as a bacterial cellulitis of the submucosa and muscularis is attributed to Cruveilhier in 1820. Three hundred and ninety cases were described in the world literature up to 1969. This case is of interest because the patient displayed a number of the typical features of the disease, and also because from a search of the literature of the past 12 years she appears to be only the second of the proven cases to have resolved with conservative management.