Acute phlegmonous gastritis in an infant

Phlegmonous Gastritis in a 32-Week Pregnant Woman Managed by Conservative Surgical Treatment and Antibiotics

“…2), histologic examination of gastric biopsies performed during the endoscopic procedure is an important step to making the diagnosis of phlegmonous gastritis. It usually shows an intense acute suppurative inflammation, especially in the submucosa, but sometimes in muscularis mucosa, with focal transmural involvement with multiple intracryptic abscesses, massive infiltration of neutrophil cells, and pseudotumoral infiltration, necrosis, or thrombus as illustrated in the present case [5,12,27]. These lesions can recover completely, as shown in many reports including the present one [6,9,12,22,23,28,29].…”

“…This clinical entity was first illustrated by Verandeaens in 1617 and then described in 1862 by Cruveilhier [3]. It is an extremely rare disease, with no more than 500 cases described in medical literature [1][2][3]12]. In the present report, our patient was diagnosed with phlegmonous gastritis during her pregnancy.…”

“…Phlegmonous gastritis was commonly reported in patients with impaired general health related to a low socioeconomic status [1], aging [1], alcoholism [1,2,18], hepatic cirrhosis [1,2,18], diabetes [1], or more specific diseases with decreased immune tolerance (e.g., T-cell leukemia [1] and HIV infection [9]). Local factors are also implicated in the genesis of phlegmonous gastritis, including acute ingestion of corrosive substances [1], alcohol intake [1,2,18], abdominal surgery [1], pyloric stenosis in children [12], duodenal or pancreatic malignancies [19], bowel ischemia [19], partial duodenal obstruction [19], long-term anti-H 2 ingestion [10], and chronic gastric or duodenal ulcer [1,18]; more recently, reports of phlegmonous gastritis have been published after invasive endoscopic procedures (repeated biliary stenting [20], mucosectomy [21]). Despite these various risk factors for phlegmonous gastritis suggesting a role for the impairment of mucosal protective factors, the pathogenesis of the disease remains largely unknown.…”

“…Sepsis and rapid clinical deterioration may be the predominant patterns, with multiple organ failure [7,22]; an unfavorable local evolution can led to the development of peritoneal signs [1,2,7,23] as in our observation. In these conditions the diagnosis is proposed by the surgeon or more frequently by histologic examination of the surgically removed part of the stomach [3,12,24,25]. When there is time enough to evaluate this potential diagnosis, ultrasound or endoscopic ultrasound [6,19,26] as well as computed tomography may be of some help in demonstrating the presence of air in the gastric wall.…”

Acute Phlegmonous Gastritis Associated with Helicobacter heilmannii Infection in a Child

“…Predisposing factors include chronic gastritis, gastric ulcer and carcinoma, protein energy malnutrition, immunocompromised states, alcoholism, hypoacidity, endoscopic procedures such as polypectomies, low socioeconomic circumstances, and increased age [5,6]. Although extremely rare in childhood, a few cases, including the case of an 11-month-old infant, have been reported [7]. The most frequent causative infective agents of phlegmonous gastritis are streptococci, staphylococci, Escherichia coli, Haemophilus influenzae, proteus, and clostridia [4].…”