Suppurative (Phlegmonous) Gastritis Presenting as a Gastric Mass

Excerpt

A 58-year-old physician with untreated chronic hepatitis B virus infection initially presented with a 2-week history of severe epigastric abdominal pain, nausea, and anorexia. The first episode of pain awoke the patient from sleep, and subsequently occurred intermittently every 2–3 h throughout the day. There was no associated vomiting. The pain was described as squeezing, episodic, and intense, lasting 5–10 s, and located in the epigastrium and right upper quadrant. The pain did not radiate to the back, shoulders, or chest. The patient reported subjective fevers and shaking chills while at home, and documented a temperature of 100.8°F orally. The epigastric pain became associated with food intake 5 days prior to admission. At this point, the discomfort was constant and unrelenting, and the patient began to note extreme anorexia in addition to early satiety. In spite of these symptoms, the patient continued to work until 3 days prior to admission. Pain medications gave him only partial relief. Eventually, even ambulating exacerbated the pain. …