A CASE OF ACUTE PHLEGMONOUS GASTRITIS WITH HEPATIC PORTAL VENOUS GAS AND A CLINICAL REVIEW OF THE JAPANESE LITERATURE

Abstract

A 23-year old man was referred to our department in May 2008 with high fever and vomiting. He had been treated in the Neurosurgery Department of our hospital for a brain tumor from 4 months previously. Because he had been suffering from unconsciousness due to the brain tumor, he was under intubation feeding. A proton pump inhibitor and a steroid hormone were administered every day to prevent peptic ulcer formation and secondary adrenal insufficiency. Enhanced CT examination showed remarkable thickness of the gastric wall and existence of gas in the portal vein. Esophagogastroendoscopy showed swelling of the gastric fold, multiple erosions, mucosal redness, and edema in the upper and the middle portion of the stomach. Endoscopic ultrasonography revealed the disappearance of normal laminated structure and some small hypoechoic lesions in the thick gastric wall. Enterobacter aerogenes and Enterococcus faecalis were cultured in the gastric juice and biopsy specimens taken from the stomach, but no pathogenic bacteria was cultured from his blood sample. Based on those findings, the patient was diagnosed as having acute phlegmonous gastritis with hepatic portal venous gas (HPVG). His clinical symptoms improved and the abnormal endoscopic and CT examination findings were normalized following the administration of antibiotics. Fifty cases of phlegmonous gastritis with and without HPVG have been reported in Japan since 1996 and their clinical features are reviewed.