Phlegmonous Gastritis Presenting as Portal Venous Pneumatosis

Abstract

Phlegmonous gastritis is a rare and highly lethal primary bacterial infection of the stomach. The pathogenesis of this disease is understood poorly and no detailed description of its associated findings on computed tomography has been reported. Case report and literature review. The authors describe an 84-year-old male with phlegmonous gastritis presenting as an abdominal catastrophe with portal venous pneumatosis observed on computed tomography. The association of portal venous air and related computed tomographic findings suggesting compromise of the gastric wall should be regarded with suspicion, and the possibility of phlegmonous gastritis should be entertained. Broad-spectrum antibiotic coverage should be instituted. Gram stain of the tissues of the stomach wall may help direct antibiotic therapy toward streptococcal infections as opposed to polymicrobial processes.