Department of Surgery, Christiana Care Health System, Christiana Hospital, Newark, DE, USA.
Surg Infect (Larchmt). 2010 Dec;11(6):545-9. doi: 10.1089/sur.2009.064. Epub 2010 Jun 24.
Phlegmonous gastritis is a rare and often fatal condition that can affect healthy individuals in 50% of cases. The condition has been described in accounts dating back to the pre-antibiotic era, during which time mortality was nearly 100%. Over the past century, case reports average about one per year. The etiology remains unclear, although Streptococcus species is isolated frequently. The optimum treatment has not been delineated clearly but likely involves a combination of antibiotics with or without surgical resection.
A case report was presented and the pertinent literature was reviewed.
A 45-year-old man with a history of recent paranasal sinus surgery presented with acute abdominal pain and criteria consistent with toxic shock syndrome. Computed tomography scan showed diffuse thickening of the gastric wall and free intraperitoneal fluid. Exploratory laparotomy revealed a thickened stomach wall with outer fibrinous exudate and murky peritoneal fluid, which grew Streptococcus pyogenes. Intraoperative esophagogastroduodenoscopy revealed thickened gastric folds with a "cobblestone" appearance and no evidence of perforation. He was treated with antibiotics intravenously and sustained a difficult intensive care unit course complicated by ventilator-dependent respiratory failure, renal failure, and coagulopathy, but survived without major disability.
This is an unusual case presentation of a rare but potentially lethal condition, whose optimal treatment is unclear. Phlegmonous gastritis should be considered when isolated gastric wall thickening is encountered in the clinical setting of toxic shock syndrome.
蜂窝织胃炎是一种罕见且常常致命的疾病，50%的健康个体可能受到影响。这种病症在抗生素问世之前的病历中就有记载，当时的死亡率接近 100%。在过去的一个世纪中，每年平均约有一例病例报告。病因仍不清楚，尽管经常分离出链球菌属。尚未明确最佳治疗方法，但可能包括抗生素联合治疗或不联合手术切除。
报告了 1 例病例并复习了相关文献。
一名 45 岁男性，有近期鼻窦手术史，出现急性腹痛和符合中毒性休克综合征的标准。计算机断层扫描显示胃壁弥漫性增厚和游离腹腔积液。剖腹探查显示胃壁增厚，伴有外层纤维蛋白性渗出物和混浊的腹腔积液，培养出酿脓链球菌。术中食管胃十二指肠镜检查显示胃皱襞增厚呈“鹅卵石”样外观，无穿孔证据。他接受静脉内抗生素治疗，并经历了困难的重症监护病房病程，伴有呼吸机依赖的呼吸衰竭、肾衰竭和凝血功能障碍，但无明显残疾而存活。
这是一种罕见但潜在致命疾病的不常见病例表现，其最佳治疗方法尚不清楚。在临床中毒性休克综合征中遇到孤立性胃壁增厚时，应考虑蜂窝织胃炎。
