CROHN HASTALIĞI İÇİN UYGULANAN STEROİD TEDAVİSİ SIRASINDA GELİŞEN AKUT FLEGMONÖZ GASTRİT

Akut flegmanöz gastrit, m ide duvarının süpüratif bakteriyel infeksiyonu ile karakterize, son derece nadir görülen ve sıklıkla ölüme neden olan klinik bir durumdur. Cruveilhier tarafından ilk kez tanımlandığı 1862 yılından bu yana, teşhis yöntemlerindeki önemli gelişmelerin olması ve elimizde çok daha etkin geniş spektrumlu antibiyotiklerin olmasına olmasına rağmen, hayatta kalabilen hasta oranı halen %58’i geçmemektedir. Bu yazıda, Crohn hastalığı nedeniyle steroid tedavisi almakta olan bir hastada gelişen akut flegmanöz gastrit vakası sunmaktayız. Sunduğumuz bu vakada olduğu gibi, bu tür bir hastayı tedavi ederken çok erken dönemde doğru tanıyı koyarak hızlı bir şeklide geniş spektrumlu bir antibiyotik kombinasyonunun başlanılmasının ve gereğinde erken dönemde enfekte dokuların cerrahi olarak uzaklaştırılmasının hasta açısından hayat kurtarıcı olabileceğini düşünmekteyiz

Acute Phlegmonous Gastritis During Steroid Treatment For Crohn's Disease

Acute phlegmonous gastritis is an extremely rare and frequently fatal condition characterized by suppurative bacterial infection of the gastric wall. Since Cruveilhier first described the condition in 1862, the proportion of affected patients who survive remains no higher than 58%, despite important advances in diagnostic techniques and the availability of more potent broad-spectrum antibiotics. In this manuscript, we present a unique case of acute phlegmonous gastritis encountered during steroid treatment for Crohn’s disease. We think that diagnosis at a very early stage and rapid treatment with a combination of broad-spectrum antibiotics, and sometimes early surgical removal of the infected tissues, may prove to be a life-saving strategy when treating such patients, as it was in the case discussed here

Keywords:

Phlegmonous gastritis pancreatitis, steroid treatment, Crohn’s disease,

PDF

___

Gerster JC. Phlegmonous gastritis. Ann Surg 1927; 85:668-82.

Cruveilhier J. In: Traite d’anatomie pathologique generate. Vol. 4. Masson et Cie; 1862, pp. 485.

Kim GY, Ward J, Henessey B, et al.(2005) Phlegmonous gastritis: case report and review. Gastrointest Endosc,61,168-74.

Starr A, Wilson JM (1957) Phlegmonous gastritis. Ann Surg,145,88-93.

Stenstrom JD, Hoehn GH (1951) Fulminating diffuse phlegmonous gastritis. Can Me d Assoc J , 64,317-19.

Horn KD. Evolving strategie s in the treatment of sepsis and systemic inflammatory response syndrome (SIRS). Q J Med 1998; 91:265-77.

Tierney LM Jr, Gooding G, Bottles K, Montgomery CK, Fiztgerald FT. Phlegmonous gastritis and Hemophilus influenzae peritonitis in a patient with alcoholic liver disease. Dig Dis Sci 1987; 32:97-101.

Mittleman RE, Suarez RV. Phlegmonous gastritis associated

with the acquired immunodeficiency syndrome/pre-acquired immunodeficiency syndrome. Arch Pathol Lab Med 1985; 109:765-67.

Yu QQ, Tariq A, Unger SW, Cabello-Inchausti B, Robinson MJ. Phlegmonous gastritis associated with Kaposi sarcoma: a case report and review of the literature. Arch Pathol Lab Med 2004; 128:801-803.

Hommel S, Savoye G, Lorenceau-Savale C, Costaglioli B, Baron F, Le Pessot B, et al. Phlegmonous gastritis in a 32-week pregnant woman managed by conservative surgical treatment and antibio tics. Dig Dis Sci 2007; 52:1042-46.

Radhi J, Kamouna M, Nyssen J. Phlegmonous gastritis following coronary bypass surgery. Can J Gastroenterol 1999; 13:837-39.

Miller AI, Smith B, Rogers AI. Phlegmonous gastritis. Gastroenterology 1975; 68:231-38.

Stein L, Greenberg RE, Ilardi CF, Kurtz L, Bank S. Acute necrotizing gastritis in a patient with peptic ulcer disease. Am J Gastroenterol 1989; 84:1552-54.

Lifton LJ, Schlossberg D. Phlegmonous gastritis after endoscopic polypectomy. Ann Intern Med 1982; 97:373-74.

Weinstein ML, Klein J. Phlegmonous gastritis. Ann Surg 1927; 86:534-39.

Morton JJ, Stabins SJ. Phlegmonous gastritis of Bacillus Aerogenes Capsu latus (B. Welchii) origin. Ann Surg 1928; 87:848-54.

Schultz MJ, van der Hulst RW, Tytgat GN. Acute phlegmonous gastritis. Gas trointest Endosc 1996; 44:80-83.

Aviles JF, Fernandez-Seara J, Barcena R, Domiinguez F, Fernandez C, Ledo L. Localized phlegmonous gastritis: endoscopic view. Endoscopy 1988; 20:38-39.

van Mook WNKA, van der Geest S, Goessens ML, Schoon EJ, Ramsay G. Gas within the wall of the stomach due to emphysematous gastritis: case report and review. Eur J Gastroenterol Hepatol 2002; 14:1155-60.

Le Scanff J, Mohammedi I, Thiebaut A, Martin O, Argaud L, Robert D. Necrotizing gastritis due to Ba cillus cereus in an immunocompromised patient. Infection 2006; 34:98-9.

Rutherford PS, Berkeley JA. Phlegmonous gastritis in a cortisone- treated patient. Can Med Assoc J 1953; 69:68-9.

Hu DC, McGrath KM, Jowell PS, Killenberg PG. Phlegmonous gastritis: successful treatment with antibiotics and resolution documented by EUS. Gastrointest Endosc 2000; 52:793-95.

Iwakiri Y, Kabemura T, Yasuda D, Okabe H, Soejima A, Miyagahara T, et al. A case of acute phlegmonous gastritis successfully treated with antibiotics. J Clin Gastroenterol 1999; 28:175-77.

Cruz FO, Soffia PS, Del Rio PM, Fava MP, Duarte IG. Acute phlegmonous gastritis with mural abscess: CT diagnosis. AJR 1992; 159:767-68.

Sood BP, Kalra N, Suri S. CT features of acute phlegmonous gastritis. Clin Imaging 2000; 24:287-88.

Franklin RG. Acute necrotizing phlegmonous gastritis. Calif Med 1962; 96:283-84.

Wakayama T, Watanabe H, Ishizaki Y, Okuyama T, Ogata H, Tanigawa K, et al. A case of phlegmonous esophagitis associated with diffuse phlegmonous gastritis. Am J Gastroenterol 1994; 89:804-06.

Blei ED, Abrahams C. Diffuse phlegmonous gastroenterocolitis in a patient with an infected peritoneo-jugular venous shunt. Gastroenterology 1983; 84:636-39.

Eliason EL, Murray-Wright VW. Acute phlegmonous gastritis. Surg Clin North Am 1938; 18:1553-64.