Phlegmonous gastritis

This rare condition should be considered when a patient presents with acute upper abdominal pain, signs of peritonitis, fever, purulent ascitic fluid, nausea or vomiting, and a normal serum amylase. It is a bacteria infection of the gastric wall, most often caused by streptococci, although staphylococci, pneu-mococci, Escherichia coli, or gas-forming bacteria can be responsible. Alcoholism, upper respiratory or other infection, peptic ulcer, endoscopic polypectomy, and gastric surgery are predisposing conditions. Vigorous antibiotic therapy should be followed immediately by laparotomy which is both diagnostic and therapeutic. Depending upon the operative findings, drainage or partial gastrectomy should be performed. Without surgery the mortality is nearly 100 percent; with surgery it is approximately 20 percent.