A case of phlegmonous gastritis with hepatic portal venous gas caused by Aeromonas hydrophila successfully treated with medication

  • Takeshi YasudaEmail author
  • Nobuaki Yagi
  • Yuki Nakahata
  • Takuya Kurobe
  • Yuriko Yasuda
  • Tatsushi Omatsu
  • Akihiro Obora
  • Takao Kojima
Case Report


A 74-year-old woman was admitted to the hospital with epigastric pain, severe nausea and vomiting, and diarrhea that had started 3 days previously. She had eaten raw Ayu fish 4 days before admission. An abdominal contrast-enhanced computed tomography scan revealed the presence of gas in the portal vein and remarkable thickening of the gastric wall. In many cases, the gas in the portal vein indicates the existence of intestinal necrosis. Esophagogastroduodenoscopy showed a submucosal tumor-like elevation in the gastric corpus. She was diagnosed with sepsis and phlegmonous gastritis (PG) with hepatic portal venous gas (HPVG) caused by Aeromonas hydrophila, which was detected in her stool. The patient was treated with antibiotics and discharged from the hospital 23 days after admission in a stable condition. When caused by PG, HPVG is not necessarily considered a poor prognostic factor and is expected to be treatable with medication. However, patients should be closely monitored for signs of a life-threatening pathology such as intestinal necrosis.


Phlegmonous gastritis Hepatic portal venous gas Aeromonas hydrophila 



The authors wish to acknowledge Dr. S. Sugie, Professor of Department of Diagnostic Pathology, Asahi University Hospital, for useful discussions. The authors thank anonymous reviewer for their helpful comments.

Compliance with ethical standards

Conflict of interest

Takeshi Yasuda, Nobuaki Yagi, Yuki Nakahata, Takuya Kurobe, Yuriko Yasuda, Tatsushi Omatsu, Obora Hiroaki, Takao Kojima declear that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Iqbal M, Saleem R, Ahmed S, et al. Successful antimicrobial treatment of phlegmonous gastritis: a case report and literature review. Case Rep Hematol. 2018;10:15. Scholar
  2. 2.
    Kim GY, Ward J, Henessey B, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc. 2005;61:168–74.CrossRefGoogle Scholar
  3. 3.
    George M, David R, Richard W. Bergey’s manual of systematic bacteriology. 2nd ed. New York: Springer; 2005. p. 556–78.Google Scholar
  4. 4.
    Honda M, Okamura H, Inoue T, et al. A case of surviving the fulminant form of Aeromonas hydrophila pneumonia due to aspiration of river water. JJAAM. 2014;25:717–22.Google Scholar
  5. 5.
    Parker JL, Shaw JG. Aeromonas spp. clinical microbiology and disease. J Infect. 2011;62:109–18.CrossRefGoogle Scholar
  6. 6.
    Janda JM, Abbott SL. The genus aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev. 2010;23:35–73.CrossRefGoogle Scholar
  7. 7.
    Gold WL, Salit IE. Aeromonas hydrophila infections of skin and soft tissue: report of 11 cases and review. Clin Infect Dis. 1993;16:69–74.CrossRefGoogle Scholar
  8. 8.
    Miller AI, Smith B, Rogers AI. Phlegmonous gastritis. Gastroenterology. 1975;68:231–8.Google Scholar
  9. 9.
    Konjetzny GE. Entgunclungen des Margens. Handbuch der speziellen pathologischen Anatomie und Histologie. 4th ed. Berlin: Springer; 1928. p. 786–1116.Google Scholar
  10. 10.
    Wolfe BJ, Evans WA. Gas in the portal veins of the liver in infants. A roentgenographic demonstration with postmortem anatomical correlation. Am J Roentgenol Radium Ther Nucl Med. 1955;74:486–9.Google Scholar
  11. 11.
    Faberman RS, Mayo-Smith WW. Outcome of 17 patients with portal venous gas detected by CT. AJR Am J Roentgenol. 1997;169:1535–8.CrossRefGoogle Scholar
  12. 12.
    Liebman PR, Patten MT, Manny J, et al. Hepatic-portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg. 1978;187:281–7.CrossRefGoogle Scholar
  13. 13.
    Kanamaru H, Yokoyama H, Shirakawa M, et al. Surgical indication of hepatic portal venous gas-our experiences of 12 cases. Jpn J Gastroenterol Surg. 2002;35:1369–76 (in Japanese, Abstract in English).CrossRefGoogle Scholar
  14. 14.
    Yamaguchi T. Experimental studies on the etiology of gas in the portal venous system. Jpn J Gastroenterol Surg. 1980;13:1260–70 (in Japanese).CrossRefGoogle Scholar
  15. 15.
    Higashida T, Nishida S, Wakasa M, et al. Hepatic portal venous gas. JJAAM. 1996;7:297–301 (in Japanese, Abstract in English).Google Scholar
  16. 16.
    Suhara S, Nakata H, Yasui S, et al. A case of phlegmonous gastritis with hepatic portal venous gas. Chiba Med J. 2006;82:277 (in Japanese).Google Scholar
  17. 17.
    Matsuda T, Hirano M, Mizutani M, et al. A case of hepatic portal venous gas caused by phlegmonous gastritis. JJAAM. 2008;19:590 (in Japanese).Google Scholar
  18. 18.
    Yasui S, Tsuchida K, Kawai T, et al. A case of portal vein gas occurring after phlegmonous gastritis and duodenitis. Gastrointest Endosc. 2009;51:213–21 (in Japanese, Abstract in English).Google Scholar
  19. 19.
    Kitagawa H, Yamamoto M, Yamasaki M, et al. A case of phlegmonous gastritis with hepatic portal venous gas. Jpn J Med Ultrasound Technol. 2010;35:218 (in Japanese).Google Scholar
  20. 20.
    Ito T, Yoneda S, Sudo M, et al. A case of acute phlegmonous gastritis with hepatic portal venous gas and a clinical review of the Japanese literature. Gastrointest Endosc. 2010;52:1698–705 (in Japanese, Abstract in English).Google Scholar
  21. 21.
    Kubo N, Sato T, Hanaoka T, et al. A case of acute phlegmonous gastritis with hepatic portal venous gas. JAEM. 2013;33:145–50 (in Japanese, Abstract in English).Google Scholar
  22. 22.
    Liu YJ, Siracuse JJ, Hauser CJ, et al. Phlegmonous gastritis presenting as portal venous pneumatosis. Surg Infect. 2013;14:221–4.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyAsahi University HospitalGifuJapan

Personalised recommendations