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767

Case

Report

d

Acute Phlegmonous CT Diagnosis Francisco

0. Cruz,1

Pablo

Gastritis

S. Soffia,1

Pedro

with Mural

M. Del Rio,1 Mario

P. Fava,1

Abscess:

and lgnacio

thickening

rate mainly because the diagnosis is usually made late [1 , 2]. Most cases have been diagnosed at autopsy and occasionally at laparotomy because the clinical presentation is often confusing. A barium study or sonography may suggest the di-

trectomy with a Billroth II anastomosis was performed. Pathologic examination of the surgical specimen (Fig. 1 0) revealed that the gastric wall was markedly thickened and exuded purulent material on slight pressure. The mucosa was covered by granular exudate and many tiny perforations. Microscopic examination

of CT.

folds

1C). A gastric wall abscess due was diagnosed. A subsequent gas-

Acute phlegmonous gastritis is an uncommon and serious bacterial infection of the gastric wall. It has a high mortality

agnosis, but the findings are not characteristic. We report a case in which a preoperative diagnosis was made by means

of the gastric

G. Duarte2

to acute phlegmonous

showed

a partially

nuclear

infiltrate

of

necrosis.

The

(Fig.

gastritis

necrotic of the pus

mucosa

submucosa,

cultures

grew

and an intense also

with

some

Escherichia

co/i

polymorphofocal and

areas Proteus

mira bills.

Case

Report

Discussion

A 78-year-old pain

and

man was admitted

melena.

The

showed thickened

abdomen

after 1 week of mild abdominal was

diffusely

gastric folds and a submucosal

tender.

Endoscopy

lesion in the gastric

antrum. Biopsy of the antrum showed nonspecific gastritis. A sonogram showed thickening of the gastric wall9”Tc-RBC scintigraphy revealed evidence of intermittent bleeding in the right upper quadrant.

CT also showed

thickening

of the gastric wall and an intramural

low-

attenuation mass in the antrum of the stomach, thought to represent a fluid collection (Figs. 1 A and 1 B). A barium study showed deformity of the gastric antrum, with rigidity of the wall and effacement and

Received 1 2

February

Department Department

AJR 159:767-768,

27, 1992;

of Radiology, of Pathology, October

accepted

after revision

Only a few cases

reported,

and most

of acute

phlegmonous

gastritis

were misdiagnosed preoperathe diagnosis has been suggested by

tively [2]. Occasionally a barium study [3] and sonography [4, 5]. In one case the diagnosis was made by using endoscopic snare biopsy [6]. In our case, the correct preoperative diagnosis of an inflammatory process rather than linitis plastica was suggested,

because collection

April 16, 1992.

in addition was

to gastric wall thickening,

seen in the gastric

a localized

wall.

Catholic University of Chile, Clinical Hospital, Marcoleta 367, Santiago, Chile. Address reprint requests to F. 0. Cruz. Catholic University of Chile, Clinical Hospital, Santiago, Chile.

1992 0361-803X/92/1594-0767

C American Roentgen

have been

of these

Ray Society

fluid

CRUZ ET AL.

768

AJR:159,

October

1992

Fig. 1.-A and B, Right lateral decubitus CT scans at different levels of

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antrum show abrupt narrowing of antral lumen (A) and an intramural low-attenuation mass in gastric wall (arrow) with marked thickening of antral wall (B). C, Upper gastrointestinal radiograph shows antral and distal body narrowing with effacement of mucosal pattern (linitis plastica pattern). 0, Pathologic specimen shows phiegmonous changes of gastric wall

and an intramural abscess.

A

B

4. Lifton

REFERENCES 1. Nevin NC, Eakins Dl, Clarke SD, Carson DJL, Brit J. Acute phiegmonous gastntis. Surgery 1969;56:268-270 2. Miller AL, Smith B, Rogers Al. Phlegmonous gastntis. 1975;68:231-238 3. Tumer MA, Beachley MC, Stanley D. Phlegmonous 1979;133:527-528

Gastroenterology gastritis.

AJR

II,

Schlossberg

D. Phiegmonous

gastritis

ectomy. Ann Intern Med 1982:97:373-374 5. Tiemey LM, Gooding G, Bottles K, Montgomery monous alcoholic

after

endoscopic

polyp-

CK, Fitzgerald FT. Phleg-

gastritis and Hemophllus influenzae peritonitis in a patient with liver disease. Dig Dis Sci i987;32:97-101 6. Bron BA, Deyhie P, Pelloni 5, Krejs GJ, Siebenmann RE, Blum AL. Phlegmonous gastritis diagnosed by endoscopic snare biopsy. Dig Dis 1977:22:729-733

Acute phlegmonous gastritis with mural abscess: CT diagnosis.

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