PHLEGMONOUS GASTRITIS

Abstract

A review of 23 documented cases of phlegmonous gastritis reported since 1945 in the American literature, and 2 new cases are presented. In a patient with a history of large ethanol intake, a recent bout of gastritis, or recent upper respiratory infection, who presents with acute upper abdominal pain, peritonitis, purulent ascitic fluid and fever, phlegmonous gastritis must be considered in the differential diagnosis. With normal serum amylase and no historical evidence of ulcer or gallbladder disease, the diagnosis becomes even more probable. Preoperative diagnosis is rare, but gastroscopy with or without biopsy and culture of gastric contents may establish the diagnosis. The definitive treatment would appear to be resection or drainage of the stomach, combined with large doses of systemic antibiotics, usually penicillin. The surgical mortality in cases reviewed was 18.2%, while the medical mortality was 100%. The overall mortality was 67%. More frequent recognition of this disease entity would lead to earlier diagnosis and a resulting lower morbidity and mortality.