Synonyms

Gastritis phlegmonosa purulenta; purulent inflammation of the stomach.

This affection usually runs an acute, and very rarely subacute course. The inflammatory process is situated in the submucous and muscular layers of the stomach, differing in this respect from acute gastritis, in which the glandular layer is affected. Phlegmonous gastritis is a very rare disease and occurs more frequently among men than women. Two forms of this affection are met with: the primary or idiopathic and the metastatic. Although the exact cause of primary purulent gastritis is as yet unknown, the symptoms and course of the morbid process justify the assumption that it is due to some micro-organism. The metastatic form occurs in pytemic and puerperal fever or severe exanthemata.

Morbid Anatomy

There may be present either a circumscribed abscess in the gastric wall (gastritis phlegmonosa circumscripta or abscess of the stomach), or a diffuse purulent infiltration. In the latter instance, numerous small abscesses of pea or hazelnut size are generally found. The mucosa over these areas appears swollen. The abscesses lie in the sub-mucosa or muscularis and often extend to the serosa. If the purulent process progresses further, perforation may occur either into the stomach or into the abdominal cavity.

Symptomatology

After the existence of dyspeptic symptoms for some time, or without any previous disturbances, the patient suddenly experiences an intense pain in his gastric region. At the same time there appear a violent burning sensation within the stomach, extreme thirst, dry tongue, and perfect anorexia. These symptoms are accompanied by high fever (103°-105° F.), with only very short intermissions. Sometimes the onset of the disease is attended by chills. The pulse is small and irregular. In most instances there is vomiting and retching, the vomited matter consisting mainly of mucus and some bile. The gastric region is very painful to pressure. The bowels are either constipated, or (as is generally the case) diarrhoea!. The disease, as a rule, ends fatally in a very short time (four to seven days). It may, however, last fourteen days. The chronic form occurs most frequently in the course of the so-called gastric abscess.

Diagnosis

An exact diagnosis of this affection can hardly be made during life. If, in connection with the above symptoms, there is an increased resistance in the gastric region with severe pain on pressure, we should think of purulent gastritis.

Treatment

The treatment should be symptomatic. Ice-cold application to the abdomen, leeches, large doses of opium, or subcutaneous injections of morphine, and, if there is collapse, camphor, ether, and the like will have to be administered.