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Korean J Gastroenterol  <  Volume 75(3); 2020 <  Articles

Korean J Gastroenterol 2020; 75(3): 157-161  https://doi.org/10.4166/kjg.2020.75.3.157
Phlegmonous Gastritis Caused by Penetration of a Toothpick
Chang Bum Rim and Sun Moon Kim
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
Correspondence to: Sun Moon Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea. Tel: +82-42-600-9370, Fax: +82-42-600-9095, E-mail: ismkim@kyuh.ac.kr, ORCID: https://orcid.org/0000-0002-0436-3381
Received: August 27, 2019; Revised: January 6, 2020; Accepted: January 20, 2020; Published online: March 25, 2020.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Phlegmonous gastritis is a disease caused by a bacterial infection of the gastric wall. This condition is rare, but when it does occur, its prognosis appears to be poor. The underlying etiology is largely unknown, but an immunocompromised state is considered an important risk factor. An 85-year-old woman presented with a confused mentality, fever, epigastric pain, and melena. There was no history of alcohol drinking or smoking, nor of previous gastric surgery. On the other hand, there was a history of senile dementia and cognitive impairment. Initial contrast-enhanced abdominal CT revealed gastric wall edema at the antrum with mucosal hyper-enhancement and an abscess in the thickened antrum. Upper gastrointestinal endoscopy on the fourth hospital day showed dark-colored fluid retention in the stomach. The gastric mucosa was inflamed and friable, with several ulcerative lesions showing purulent discharge. A toothpick was found in the process of identifying the base of the ulcerative lesion and was removed. Eventually, phlegmonous gastritis due to the penetration of a toothpick was diagnosed. After endoscopic toothpick removal, the patient's symptoms improved dramatically. Serial endoscopy revealed improvement in the gastric mucosa. This case is an example of phlegmonous gastritis caused by a foreign substance in the gastric wall of a patient with senile dementia. During upper gastrointestinal endoscopy in this case, identification of the base of ulcerative lesion played a critical role in the diagnosis.
Keywords: Dementia; Foreign bodies; Phlegmonous gastritis; Endoscopy


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