Description

ABSTRACT

With only 500 cases reported in the world, Acute Necrotizing Gastritis, a variant of Phlegmonous Gastritis is a rare, yet a potentially fatal condition. Phlegmonous Gastritis means abscess or spreading cellulitis of the stomach wall caused by microorganisms and the condition when these organisms cause necrosis and gangrene of the stomach wall is called Acute Necrotizing Gastritis.

We report a case of a 17year old boy who presented with acute abdominal pain and vomiting since 1 day and with early features of shock. Abdominal guarding and rigidity and free air under diaphragm on erect abdominal X-ray called for an emergency exploratory laparotomy, where a 5x6cm, greater curvature stomach gangrene with full thickness posterior wall perforation totally surprised the surgeons. All  proposed etiological factors for stomach gangrene like embolization of atherosclerotic plaque, thrombosis of major artery, occlusion of gastric vessels by therapeutically injected foreign bodies, psychogenic polyphagia resulting in massive gastric dilatation, ingestion of corrosive materials, intrathoracic herniation of the stomach through the diaphragm or gastric volvulus were ruled out and the possibility of severe necrotizing gastritis caused by organisms was considered and confirmed by isolation of streprococcus in the peritoneal cavity.

Wide excision of the gangrenous segment with primary closure of the stomach was done. With prompt and aggressive medical management, supportive and nutritional care we were able to rescue the patient from the fatal condition and the patient lives to tell the tale.

KEYWORDS:  Phlegmonous Gastritis, Acute Necrotizing Gastritis, Stomach gangrene, Stomach perforation.