LAUSR

A 73-year-old gentleman was admitted with a 4-day history of increasing epigastric pain with associated nausea. Two weeks prior, the patient reported a flu-like illness, consisting of subjective fevers, headache and myalgias. No vomiting or bowel changes had been noted. The patient could not recall any post prandial pain or ingesting bony material prior to his presentation. His general health was very good with well-controlled hypertension and no previous abdominal operations. He is a non-smoker and non-drinker. His examination revealed normal vitals and voluntary guarding in the RUQ and epigastrium with a WCC of 15 and CRP 83. A computed tomography (CT) scan revealed a complex, intramural gastric abscess involving the lesser curve and extending into segment 3 of the liver (Fig. 1). The patient was admitted, kept nil by mouth and IV ceftriaxone and metronidazole was commenced after discussion with infectious disease. Clinical and biochemical improvement over the first 48 h allowed conservative management and a repeat CT scan undertaken at day 5 showed a smaller collection (Fig. 2). He was discharged 6 days post admission on oral antibiotics, pain free with normalization of his WCC and CRP. An interval gastroscopy and biopsies revealed no abnormalities and did not elucidate a cause, a follow-up endoscopic ultrasound (EUS) 1 month post discharge showed resolution of the intramural gastric abscesses and no focal lesions (Fig. 3). Suppurative gastritis is a rare but recognized, purulent inflammatory process involving the gastric wall and can be divided into diffuse, localized or mixed forms. Intra-mural gastric abscesses represent the localized form and are a rare entity with 20 cases reported in the English literature. Our case is the first to successfully treat an intramural gastric abscess with antibiotics alone.