2674 Laying a Gastric Wall Abscess to Rest

Abstract

INTRODUCTION: Gastric wall abscess (GWA) or localized suppurative gastritis is a purulent inflammatory process of the submucosa of the stomach associated with high mortality rates. GWA can be a rare complication of subepithelial lesions (SEL), such as ectopic pancreas (pancreatic rest), GIST, and leiomyosarcoma. Our report is the fourth demonstrated case of pancreatic rest associated GWA and the first in an extensive literature search with successful treatment without adjunctive surgical resection. CASE DESCRIPTION/METHODS: 38-year-old healthy female presented to our Gastroenterology clinic for persistent abdominal pain with nausea and vomiting after being evaluated 3 days ago at an outside hospital (OSH) (Table 1). She was diagnosed with gastritis and sent home on omeprazole. At our institution, she described her pain as sharp, constant, non-radiating and diffuse, but worst in the epigastrium postprandially. Social history was remarkable for 1-2 drinks per day and recent travel to Peru 3-4 weeks prior. As she appeared acutely ill, the patient was referred to ED, with initial work up remarkable for blood pressure of 93/54 and WBC of 13.5. EGD revealed a large submucosal gastric mass in the distal gastric antrum with central umbilication and expressible white purulent material (Figure 1). She was started on pip/tazo and ID was consulted. Micro was largely negative; however, culture of purulent material was unable to be processed. Pathology showed active gastritis, focal ulceration, and necro-inflammatory tissue without evidence of malignancy. Cytology revealed purulent exudate associated with bacterial colonies consistent with abscess. The patient clinically improved and was discharged home on Augmentin. In outpatient follow up, patient reported continued improvement. Follow up EGD revealed resolution of abscess, however pancreatic rest was seen in the gastric antrum (Figure 2). DISCUSSION: GWA is a rare and highly morbid condition commonly located in the antrum or pylorus. Exact pathogenesis may be due to direct bacterial seeding or hematogenous spread. Strep species are the most commonly isolated bacteria. GWA is rarely also associated with a SEL, in our case being a pancreatic rest, or ectopic pancreatic tissue. Treatment for SEL associated GWA has traditionally been surgical removal with either partial gastrectomy or wedge resection. Our case report demonstrates the safety and efficacy of drainage and medical management alone.