Gastric outlet obstruction induced by a gastric wall abscess after cholecystitis

Intramural gastric abscesses in a dog

A 6-year-old, female neutered Labrador retriever was presented with a chronic history of vomiting and anorexia. Abdominal ultrasound identified two large cavitated structures with echogenic content in the gastric fundus and pyloric region. CT revealed the intraparietal nature of these structures, one in the greater curvature and another one extending from the lesser curvature to the pyloric antrum. Surgical exploration revealed two areas of thickened gastric wall with intramural purulent material. Debridement and partial resection of the abscess (deroofing) were performed via a routine gastrotomy approach. Histopathology of a gastric wall sample revealed neutrophilic inflammation with intralesional vegetal foreign body. The presence of intralesional foreign body with a positive bacterial culture and macroscopic absence of peritonitis may suggest an intramural migrating vegetal foreign body. Gastric wall abscess should be included in a differential diagnosis in dogs with a history of chronic vomiting and the presence of gastric wall cavitated structures. Surgical debridement through a routine gastrotomy opening alleviated the clinical signs related to the intramural gastric abscesses in this dog with no recurrence at 22 months.

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.

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

A gastric bezoar is a compact mass of indigestible foreign materials that accumulate and consolidate in the stomach; however, it can be found in other sites of the gastrointestinal tract. The causative manner of this condition is complex and multifactorial. The main purpose of the review was to raise awareness among clinicians, particularly gastroenterologists, that patients with certain risk factors or comorbid conditions are predisposed to gastric bezoar formation. Early diagnosis and prompt intervention are crucial to avoid bezoar-induced complications. Upper gastrointestinal endoscopy is the standard diagnostic and therapeutic method for gastric bezoars. However, for large size bezoars, surgical intervention is needed.

Phlegmonous Gastritis: A Report of Three Cases with Clinical and Imaging Features

Phlegmonous gastritis is a rare but often fatal acute pyogenic infection of the stomach. We herein report three cases of phlegmonous gastritis with different causes: the long-term placement of a nasogastric feeding tube, bacteremia associated with cellulitis in a diabetic patient, and an adverse reaction to paclitaxel/carboplatin chemotherapy for cancer of unknown primary cause, which were classified as primary, secondary, and idiopathic types, respectively. Coping with the increasing morbidity rate associated with the diverse background of such patients requires a thorough understanding of the clinical features and image findings associated with this entity.

Etiological aspects of intragastric bezoars and its associations to the gastric function implications: A case report and a literature review

RATIONALE

Intragastric bezoar is a stony mass found trapped in the stomach, though it can occur in other locations of the gastro-intestinal tract. The etiology of intragastric bezoar is multifactorial, includes certain risk factors and predisposing factors such as coexisting medical disorders, anatomic abnormalities, and gastric motility disorders, which contribute to the development of intragastric bezoar.

PATIENT CONCERNS

In this report, we present a rare case of intragastric bezoar with epigastric pain after prolonged consumption of jujubes. To our knowledge, this is the first case of intragastric bezoar to be reported after jujubes ingestion.

DIAGNOSES

An upper gastrointestinal (GI) endoscopy performed which revealed an 8 × 5-cm intragastric diospyrobezoar with an adjacent necrotic pressure ulcer of size 0.8 × 0.5-cm without signs of bleeding.

INTERVENTIONS

For therapeutic intervention, Coca-Cola ingestion and lithotripsy were applied.

OUTCOMES

The therapeutic course was uneventful. There was no recurrence during 1-year follow-up.

LESSONS

In our literature, jujube emerged as a new player. A bezoar composed of unripened fruit content in the stomach, could be the cause of chronic abdominal pain, dyspepsia, gastric reflux or heartburn. Moreover, this study provides a detailed overview of recently published literature regarding intragastric manifestations of bezoar, etiological factors, diagnostic and therapeutic approaches.