Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Surgery, Scarborough Health Network, University of Toronto, 3030 Lawrence Avenue East, suite 414, Toronto, ON, M1P 2T7, Canada.
BMC Surg. 2021 Jan 4;21(1):5. doi: 10.1186/s12893-020-00999-y.
Phlegmonous gastritis (PG) is a rare, suppurative bacterial infection of the gastric wall, which may rapidly evolve into fatal septicemia. The etiology and pathogenesis are poorly understood; however, multiple risk factors have been cited in current literature. Most cases have been diagnosed at autopsy, and occasionally at laparotomy, as the clinical presentation is often variable.
We report a case of a 67-year-old male presenting with intractable nausea, vomiting, and epigastric pain following an uneventful upper gastrointestinal (GI) endoscopy. Diagnostic workup including contrast tomography (CT) and endoscopic assessment was in keeping with PG. This was subsequently followed by development of abdominal compartment syndrome (ACS) and clinical deterioration necessitating surgical resection of the stomach.
This case emphasizes the importance of early diagnosis of this potentially fatal infection that can follow endoscopic procedures and illustrates ACS and septic shock as serious complications. There is currently no consensus on the proper management of PG; however, in this case, a combination of surgery and antibiotics provided a favourable outcome. Limited number of cases of PG have been reported in literature, and to our knowledge, this is the first reported case of PG with subsequent ACS as an acute complication.
蜂窝织胃炎（PG）是一种罕见的胃壁化脓性细菌感染，可能迅速发展为致命的败血症。其病因和发病机制尚不清楚；然而，目前文献中已经提出了多种危险因素。大多数病例是在尸检时诊断出来的，偶尔在剖腹手术时诊断出来，因为临床表现通常是多变的。
我们报告了一例 67 岁男性病例，在上消化道（GI）内镜检查后出现顽固的恶心、呕吐和上腹痛。包括对比断层扫描（CT）和内镜评估在内的诊断性检查符合 PG。随后发展为腹腔间隔室综合征（ACS）和临床恶化，需要进行胃切除术。
本病例强调了对这种可能致命的感染的早期诊断的重要性，这种感染可能在内镜检查后发生，并说明了 ACS 和感染性休克是严重的并发症。目前对于 PG 的适当治疗方法尚无共识；然而，在这种情况下，手术和抗生素的联合治疗提供了有利的结果。文献中报道的 PG 病例数量有限，据我们所知，这是首例报告的 PG 病例，随后出现 ACS 作为急性并发症。
