ACUTE DIFFUSE PHLEGMONOUS OESOPHAGITIS: A MEDICAL RARITY

March 23, 2024

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Presented in 13th World Gastroenterology, IBD & Hepatology Conference in Holiday Inn Dubai, Al Barsha, UAE & Virtual from December 15-17, 2023.

Poster Name: Dr. Stephanie Kahura
Category: Poster presentation
Biography: Stephanie Kahura has completed her Bachelors in Biomedical Sciences in addition to an MD degree with distinctions from the University Of Nicosia Medical School, Cyprus. She was thereafter appointed to the Oxford Deanery for foundation training that was successfully completed in August 2022. She is currently a foundation year 3 doctor in Oxford working on various research projects in line with the National Institute for Health Research.

S W. Kahura1 and E. A. Johns2 , Foundation Year 3 Doctor1 (Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Road, Aylesbury, United Kingdom, HP21 8AL, Gastroenterology Consultant2 (Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Road, Aylesbury, United Kingdom, HP21 8AL.

Global Journal of Gastroenterology & Hepatology Research [GJGHR]

Introduction: Acute diffuse phlegmonous oesophagitis, a scarcely reported ailment, is marked by purulent inflammation of both the submucosal and muscularis layers of the oesophagus (Kim et al., 2010). Our comprehension of the underlying pathophysiology remains vague due to the few detailed sightings of it thus far.

Case Presentation: An 86-year-old man presented to his General Practitioner with a 3-month history of rapid, unintentional weight loss, mild dysphagia and recurrent fevers. Initial blood work revealed mild neutrophilia in addition to raised inflammatory markers. The main diagnostic investigation, Computed Tomography scanning, was done while in the Accident and Emergency Room of Stoke Mandeville Hospital. The findings of said scan paired with markedly elevated infection markers were highly concerning for acute diffuse phlegmonous oesophagitis.

Outcome: Unfortunately, the patient has since passed due to mediastinal complications of the condition despite best aggressive medical management. This goes to support the high mortality rate discussed in medical literature.

Follow Up Discussion: Although the exact aetiologies of the condition remain unclear, there have been several predispositions noted. Acute phlegmonous oesophagitis affects the middle-aged population with a male predominance. Overall, there is a dire need for the further exploration of the illness due to its high risk for continued complications. Patients require early diagnosis to better their prognosis (Shin et al., 2018).

Digital Formats:

Fig 1 – Computed Tomography scan of the chest, abdomen and pelvis: severe relatively concentrical thickening of most of the oesophagus, especially of the oesophageal wall over approx- imately 15.5 cm in length

Fig 2 – Chest X-ray: left-sided chest drain in situ with residual left pleural effusion. Additional small right pleural effusion and progressive mid and lower zone consolidation.

References:

Kim HS, Hwang JH, Hong SS, Chang WH, Kim HJ, Chang YW, et al. Acute diffuse phlegmonous esophagogastritis: A case Journal of Korean Medical Science. 2010;25(10):1532.
Shin HS, Kim SS, Kim JH. Acute phlegmonous esopha- gitis with mediastinitis complicated by an esophageal perfora- tion: A case report. Journal of the Korean Society of Radiology. 2018;79(1):45.

Keywords: phlegmonous infection, oesophagitis, pleural effusion