Overview.
Cellulitis gastrica is a rare disease that is a severe bacterial infectious inflammation of the submucosa of the stomach. The bacterial infection may involve the entire stomach or may be limited to a portion of the gastric wall, most commonly the antrum. Submucosal cellulitis is often limited to the gastric wall, but may also spread to the esophagus and even from the stomach to the descending colon. The disease can be divided into two categories: acute diffuse (also called acute suppurative gastritis) and chronic limited. The former has a high incidence and a high risk, while the latter has a low incidence and a better prognosis.
Etiology
Pathogenic bacteria can come from the stomach cavity, and the invasion pathway is mainly the lesion of the stomach wall itself, such as ulcers, trauma, cancer and surgical incisions, etc., and can also be from other parts of the body such as tonsillitis, periodontitis and skin abscesses through the blood transport. The causative organism is mainly hemolytic streptococcus, followed by Escherichia coli and Bacillus subtilis.
Symptoms
The onset of the disease is rapid, and the main symptoms include severe pain in the epigastrium, nausea and vomiting, chills and high fever, sometimes accompanied by diarrhea. Physical examination can find obvious pressure pain in the epigastrium, sometimes with muscle tension. With the development of the disease, systemic toxic symptoms may appear, and the white blood cell count is obviously increased. Due to the rarity of the disease and the clinical manifestation of acute abdomen, it is often misdiagnosed as acute perforation of ulcer disease, acute pancreatitis, acute cholecystitis, etc. and dissected. Necrosis and perforation may occur in severe cases of this disease.
Examination
1. Laboratory examination
Peripheral blood leukocyte count is elevated, mostly above 1×1010/L, with neutrophils predominating and leftward nuclear shift. Bacterial culture of gastric fluid, ascites and blood can detect pathogenic bacteria.
2. Imaging examination
(1) X-ray plain film of the abdomen: it shows gastric dilatation and the presence of gas bubbles in the gastric wall.
(2) X-ray barium meal and gastroscopy: generally contraindicated in the acute stage to avoid gastric perforation. Retrospective gastroscopy data show narrow gastric lumen, congestion and thickening of gastric mucosa, pus moss adherence on mucosal surface, which may be accompanied by multiple ulcers.
(3) B-mode ultrasonography: shows obvious thickening of the gastric wall.
Diagnosis
The disease lacks specific symptoms and signs, and auxiliary examination has few specific indicators, so the diagnosis is difficult. The key is to consider the possibility of septic gastritis in acute abdomen, and the presence of small air bubbles in the stomach wall during X-ray examination is also helpful for diagnosis. During surgery, the diagnosis can be made based on the presence of obvious inflammatory infiltration, edema and thickening of the gastric wall (sometimes limited necrosis of the gastric wall can be found).
Treatment
If the diagnosis of this disease is clear, systemic supportive therapy should be actively adopted, such as applying antibiotics, replenishing fluids, maintaining electrolyte and acid-base balance, especially antibiotic treatment is the most important. If surgery is performed because of necrotic perforation or misdiagnosis of other acute abdominal diseases, appropriate measures can be taken according to the extent and degree of the lesion. If the lesion is confined to the distal orifice of the stomach and the patient’s general condition permits, partial gastrectomy should be performed; if the patient’s condition is poor or the local conditions are not conducive to accepting gastrectomy, simple suture and gastrostomy can be considered, and systemic support and antibiotic therapy should be continued after the operation.