16162              PHLEGMONOUS GASTRITIS

The patient was a man aged 64.  A year previously anorexia, epigastric pain and nausea led to barium meal and gastroscopy which showed a benign gastric ulcer 1 cm in diameter high on the lesser curvature.  Alkali treatment was begun. He was readmitted 8 months after a severe haematemesis.  There was marked anorexia, he had lost more than 13 kg in weight and the haemoglobin was 9 g%.  Small haematemeses continued and laparotomy was performed.  The stomach was found grossly distended with 1100 ml of old blood and there were many acute mucosal ulcers.  Antrectomy with jejunal anastomosis was performed.  He died a day later.

The specimen consists of the residual portion of the stomach and the proximal part of the anastomosed jejunum.  The gastric wall is intensely congested, swollen and inflamed, and the mucosal surface is covered by shaggy exudate and necrotic tissue.  The change does not extend into the small bowel.  Histology shows phlegmonous oedema and acute suppurative inflammation.