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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
Downloaded from www.ajronline.org by 202.83.102.136 on 11/11/15 from IP address 202.83.102.136. Copyright ARRS. For personal use only; all rights reserved
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