Phlegmonous gastritis, also known as phlegmonitis of the stomach, is an uncommon, life-threatening condition which is due to diffuse infection of the submucosa of the stomach.
Although the gastric form is the commonest type of phlegmonitis seen in the gastrointestinal tract, it remains rare, with total published cases numbering just over 100 1. Mortality is high, with a death rate of 42% 1.
- increasing age
- diabetes mellitus
- gastric ulcers 3
- excessive proton pump inhibitor use
- iatrogenic: gastric surgery, forceful procedures including upper GI endoscopy and nasogastric tube insertion 2,3
- septicemia 3
Streptococcus spp. have been found to be the most common causative organisms, accounting for about two-third of cases 2.
There are two main forms of phlegmonous gastritis: diffuse or localized.
Diffuse involves the complete stomach, conversely localized disease most commonly is restricted to the antrum. It is unusual for the cardia or the pylorus to be involved 1,2.
Occasionally phlegmonitis of the esophagus coexists, in which case the condition is described as phlegmonous oesophagogastritis.
CT findings of phlegmonous gastritis include diffuse gastric mural thickening with intramural hypodensities, the latter representing submucosal abscesses contained within the wall 2.
Treatment and prognosis
Phlegmonous gastritis therapy requires aggressive supportive care with powerful antimicrobial agents. Occasionally surgery might be required.
There is risk of developing peritonitis is 70% of cases. A severely contracted stomach may result from healing 3.
- 1. Huang YC, Cheng CY, Liao CY, Hsueh C, Tyan YS, Ho SY. A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation. (2017) The American journal of case reports. 18: 125-130. Pubmed
- 2. Ishioka M, Watanabe N, Sawaguchi M, Fukuda S, Shiga H, Matsuhashi T, Jin M, Iijima K. Phlegmonous Gastritis: A Report of Three Cases with Clinical and Imaging Features. (2018) Internal medicine (Tokyo, Japan). 57 (15): 2185-2188. doi:10.2169/internalmedicine.0707-17 - Pubmed
- 3. Jeffrey Klein, Emily N. Vinson, Clyde A. Helms, William E. Brant. Brant and Helms' Fundamentals of Diagnostic Radiology. (2018) ISBN: 9781496367396