Clin Endosc.  2023 Jan;56(1):114-118. 10.5946/ce.2021.203.

Gastric wall abscess after endoscopic submucosal dissection

• Yu SJ
• Lee SH
• Yoon JS
• Lee HS
• Jee SR

• KMID: 2538759
• DOI: http://doi.org/10.5946/ce.2021.203

Abstract

Gastric wall abscess, a localized form of phlegmonous gastritis, is a rare complication of endoscopic resection. We report the first case of gastric wall abscess developing after endoscopic submucosal dissection in Korea. A 72-year-old woman visited our clinic to receive treatment for gastric adenoma. The patient successfully underwent endoscopic submucosal dissection with no complications. The final diagnosis was well-differentiated tubular adenocarcinoma. We performed follow-up endoscopy 10 weeks later and found a large subepithelial lesion on the posterior wall of the gastric antrum. Abdominal computed tomography revealed hypodense wall thickening and a 5 cm heterogenous multilobular mass in the submucosal layer of the gastric antrum. Submucosal invasion with mucin-producing adenocarcinomas could therefore not be excluded. The patient agreed to undergo additional gastrectomy due to the possibility of a highly malignant lesion. The final diagnosis was acute suppurative inflammation with the formation of multiple abscesses in the mural layers and omentum. The patient was discharged with no complications.

Keyword

Early gastric cancer; Endoscopic submucosal resection; Gastric wall abscess; Phlegmonous gastritis

Figure

• 

  Fig. 1. Endoscopic submucosal dissection to remove the lesion. (A) An ulcerated lesion on the anterior wall side of the proximal antrum. (B) The lesion was marked using an endoscopic knife. (C) Dissection of the submucosal layer was performed. (D) A resected specimen.

• 

  Fig. 2. (A, B) A 5-cm sized subepithelial lesion was observed on the posterior wall of the gastric antrum during the follow-up endoscopy.

• 

  Fig. 3. (A, B) Computed tomography was performed after the subepithelial lesion was discovered. Hypodense wall thickening and a 5-cm sized heterogenous multilobular submucosal mass was observed in the gastric antrum. Local infiltration into the peripheral omentum was also observed.

• 

  Fig. 4. Postoperative histological findings. (A, B) Acute suppurative gastritis with multifocal abscess formation and the infiltration of inflammatory cells in all layers of the stomach was seen (hematoxylin and eosin stain, ×15 and ×200).

Reference

1. Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc. 2021; 33:4–20.

2. Kim GY, Ward J, Henessey B, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc. 2005; 61:168–174.

3. Schultz MJ, van der Hulst RW, Tytgat GN. Acute phlegmonous gastritis. Gastrointest Endosc. 1996; 44:80–83.

4. Eley A, Richards HG. A case of localized gastric abscess. Br J Surg. 1959; 47:97–98.

5. Choong NWW, Levy MJ, Rajan E, et al. Intramural gastric abscess: case history and review. Gastrointest Endosc. 2003; 58:627–629.

6. Ajibe H, Osawa H, Yoshizawa M, et al. Phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer. Therap Adv Gastroenterol. 2008; 1:91–95.

7. Dohi O, Dohi M, Inoue K, et al. Endoscopic transgastric drainage of a gastric wall abscess after endoscopic submucosal dissection. World J Gastroenterol. 2014; 20:1119–1122.

8. Matsuura K, Hiramatsu S, Taketani R, et al. Medical treatment of postendoscopic submucosal dissection phlegmonous gastritis in an elderly diabetic woman with myelodysplastic syndrome. Case Rep Gastrointest Med. 2018; 2018:8046817.

9. Lee BS, Kim SM, Seong JK, et al. Phlegmonous gastritis after endoscopic mucosal resection. Endoscopy. 2005; 37:490–493.

10. Jung JY, Kim JS, Kim BW, et al. Perigastric abscess as a complication of endoscopic submucosal dissection for early gastric cancer: first case report. Korean J Gastroenterol. 2016; 67:142–145.

11. Asayama N, Nagata S, Yukutake M, et al. A rare case of delayed perigastric abscess after curative resection of early gastric cancer by uncomplicated endoscopic submucosal dissection: successful treatment with endoscopic ultrasound-guided drainage. Intern Med. 2021; 60:1383–1387.

12. Miyaguchi K, Tashima T, Sugimoto K, et al. Intraperitoneal abscess as a postoperative complication of gastric endoscopic submucosal dissection. Intern Med. 2021; 60:2777–2781.

13. Asrani A, Novelline R, Abujudeh H, et al. Intramural gastric abscess--preoperative diagnosis with CT. Emerg Radiol. 2007; 14:253–256.