A Case of Gastric Abscess Accompanying Acute Cholecystitis

Abstract

The patient was a 59-year-old woman with the chief complaints of abdominal pain and fever. Upon palpation of a tumor the size of an egg accompanied by precordial tenderness, she was hospitalized. Leukocytosis and positive CRP were observed, and abdominal US and CT revealed a tumor measuring 40 mm by 60 mm protruding out of the stomach wall. Endoscopic examination of the upper gastrointestinal tract disclosed a smooth-surfaced hemispheric elevation near the posterior wall of the antrum, and a white pus-like exudate was seen oozing from part of the mass. As she was suspected of having gastric abscess, an antibiotic was administered to control IVH. The symptoms and inflammatory reaction improved, and the tumor was reduced in size on the scan. On the 26th hospital day, however, subtotal gastrectomy and cholecystectomy were performed. At surgery, a tumor measuring 30 mm by 53 mm was seen adhering to the ligament of the transverse colon near the posterior wall of the antrum. The gallbladder wall was prominently thickened, and the gallbladder was found to contain many bilirubin stones. Considering that the gallbladder showed notable adhesion to the surrounding organs, gastric abscess seemed to have developed from pericholecystitis.