Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Gastric Wall Abscess Caused by a Fish Bone and Treated with Endoscopic Management

내시경적 배액술로 치료한 생선뼈에 의한 위벽내 농양 1예

  • Jun, Won-Jung (Department of Internal Medicine, Chonnam National University College of Medicine) ;
  • Rew, Jong-Sun (Department of Internal Medicine, Chonnam National University College of Medicine) ;
  • Cho, Yong-Chan (Department of Internal Medicine, Chonnam National University College of Medicine) ;
  • Noh, Du-Young (Department of Internal Medicine, Chonnam National University College of Medicine) ;
  • Kim, Sung-Kyun (Department of Internal Medicine, Chonnam National University College of Medicine) ;
  • Kim, Hyen-Soo (Department of Internal Medicine, Chonnam National University College of Medicine) ;
  • Choi, Sung-Kyu (Department of Internal Medicine, Chonnam National University College of Medicine)
  • 전원정 (전남대학교 의과대학 내과학교실) ;
  • 류종선 (전남대학교 의과대학 내과학교실) ;
  • 조용찬 (전남대학교 의과대학 내과학교실) ;
  • 노두영 (전남대학교 의과대학 내과학교실) ;
  • 김성균 (전남대학교 의과대학 내과학교실) ;
  • 김현수 (전남대학교 의과대학 내과학교실) ;
  • 최성규 (전남대학교 의과대학 내과학교실)
  • Received : 2010.01.18
  • Accepted : 2010.07.04
  • Published : 2010.08.30
⟨ Previous Next ⟩

Abstract

Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus.

위벽내 농양은 화농 위염의 국소적인 형태로 극히 드물게 발생한다. 화농 위염은 그 침범 정도에 따라서 미만형과 국소형으로 나뉜다. 미만형은 위를 전체적으로 침범하게 되며 점막하층으로부터 전층에 염증소견을 나타낸다. 국소적인 형태를 위벽내 농양이라 정의하며 전체의 5~15%를 차지하고 있다. 위벽내 농양은 미생물의 직접적인 침윤 혹은 원발 부위로부터의 혈행성 전파에 의해 발생하는 것으로 알려져 있으며 이물질 특히 생선 가시의 섭취나 내시경 용종 절제술, 위궤양 등과 관련한 점막손상이 원인이 될 수 있다. 저자 등은 드문 질환인 위벽내 농양을 상부위장관내시경 검사와 복부 전산화 단층촬영을 통해 진단하고 내시경 절개와 배농을 통해 성공적인 치료를 경험하였기에 보고한다.

Keywords

References

  1. Gerster JC. Phlegmonous gastritis. Ann Surg 1927;85:668-682. https://doi.org/10.1097/00000658-192705000-00006
  2. Nevin NC, Eakins D, Clarke SD, Carson DJ. Acute phlegmonous gastritis. Br J Surg 1969;56:268-270. https://doi.org/10.1002/bjs.1800560407
  3. Miller AI, Smith B, Rogers AI. Phlegmonous gastritis. Gastroenterology 1975;68:231-238.
  4. Seidel RH Jr, Burdick JS. Gastric leiomyosarcoma presenting as a gastric wall abscess. Am J Gastroenterol 1998;93:2241-2244. https://doi.org/10.1111/j.1572-0241.1998.00625.x
  5. Murphy JF, Graham DY, Frankel NB, Spjut HJ. Intramural gastric abscess. Am J Surg 1976;131:618-621. https://doi.org/10.1016/0002-9610(76)90028-3
  6. Berk RN, Reit RJ. Intra-abdominal chicken bone abscess. Radiology 1971;101:311-313. https://doi.org/10.1148/101.2.311
  7. Choong NW, Levy MJ, Rajan E, Kolars JC. Intramural gastric abscess: case history and review. Gastrointest Endosc 2003;58: 627-629.
  8. Asrani A, Novelline R, Abujudeh H, Lawrason J, Kaewlai R. Intramural gastric abscess--preoperative diagnosis with CT. Emerg Radiol 2007;14:253-256. https://doi.org/10.1007/s10140-007-0589-x
  9. Vandyk K, German JD. Empyema of the gall bladder causing gastroduoedenal intramural abscess and pyloric obstruction. Am J Surg 1967;113:295-297. https://doi.org/10.1016/0002-9610(67)90242-5
  10. Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg 1996;20:1001-1005. https://doi.org/10.1007/s002689900152
  11. Weissberg D. Foreign bodies in the gastro-intestinal tract. S Afr J Surg 1991;29:150-153.
  12. Smith GE. Subacute phlegmonous gastritis simulating intramural neoplasm: case report and review. Gastrointest Endosc 1972;19:23-26. https://doi.org/10.1016/S0016-5107(72)73938-3
  13. Frank P, Behnke KH, Behrmann E. Stomach lining abscess following perforation by poultry bones: a rare and unusual differential diagnosis from stomach carcinoma. 1980;133:325-326. https://doi.org/10.1055/s-2008-1056737
  14. Fernandez-Urien I, Subtil JC, Herraiz M, et al. Gastric abscess. Gastrointest Endosc 2004;59:396-397. https://doi.org/10.1016/S0016-5107(03)02589-6
  15. Katsinelos P, Chatzimavroudis G, Zavos C, Triantafillidis I, Kountouras J. A pyogenous gastric abscess that developed following ingestion of a piece of a wooden skewer: successful treatment with endoscopic incision. J Gastrointestin Liver Dis 2007;16:113-115.
  16. Ruiz-Rebollo ML, Atienza-Sanchez R, Gomez-Corral J. Gastric wall abscess caused by an ingested toothpick. Gastrointest Endosc 2007;65:518-519. https://doi.org/10.1016/j.gie.2006.11.023
  17. Schultz MJ, van der Hulst RW, Tytgat GN. Acute phlegmonous gastritis. Gastrointest Endosc 1996;44:80-83. https://doi.org/10.1016/S0016-5107(96)70236-5
  18. Kang BC, Kim KW, Lee SW, Kim JH. Gastric wall abscess: imaging diagnosis and endoscopic treatment. J Comput Assist Tomogr 1998;22:673-675. https://doi.org/10.1097/00004728-199807000-00032