A Rare Complication of Acute Phlegmonous Gastritis: Right Gastroepiploic Artery Aneurysm and Abdominal Hemorrhage

Background: Acute phlegmonous gastritis (APG) is an unusual disorder characterized by a diffuse suppurative infection of the stomach. Although the clinical features of APG are non-specific, it is a serious condition that may lead to life-threatening complications. Therefore, early diagnosis and treatment are crucial.
Case Report: A 67-year-old female presented with severe acute abdominal pain, high fever, vomiting, and clouding of consciousness. She had a history of diabetes mellitus for 18 years and was using insulin therapy. A physical examination revealed diffuse abdominal guarding. An abdominal computed tomography (CT) examination showed diffuse wall thickening affecting the entire stomach, which was suspicious for malignancy. Moreover, the CT revealed a gastroepiploic artery aneurysm and abdominal free fluid with high attenuation, suggesting abdominal hemorrhage. An urgent upper gastrointestinal endoscopy revealed dark-colored and thickened gastric mucosa with several ulcerations, consistent with acute phlegmonous gastritis (APG).
Conclusion: APG is a life-threatening condition. Early diagnosis and appropriate treatment are vital. APG should be kept in mind in the differential diagnosis of an acute abdomen, especially in diabetic or elderly patients.