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Phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer

Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan

Hiroyuki Osawa

Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan, osawa{at}jichi.ac.jp

Mitsuyo Yoshizawa

Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan

Hironori Yamamoto

Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan

Kiichi Satoh

Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan

Koji Koinuma

Department of Surgery, Jichi Medical University, Tochigi, Japan

Kazue Morishima

Department of Surgery, Jichi Medical University, Tochigi, Japan

Yoshinori Hosoya

Department of Surgery, Jichi Medical University, Tochigi, Japan

Yoshikazu Yasuda

Department of Surgery, Jichi Medical University, Tochigi, Japan

Kentaro Sugano

Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan

A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.

Key Words: Phlegmonous gastritis • severe complication • early gastric cancer • endoscopic submucosal dissection

Therapeutic Advances in Gastroenterology, Vol. 1, No. 2, 91-95 (2008)
DOI: 10.1177/1756283X08095746


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