|Year : 2016 | Volume
| Issue : 3 | Page : 146-147
Idiopathic granulomatous gastritis with severe gastrointestinal bleeding
Nazim Gures MD, MSc , Mustafa Erol
Department of General Surgery, Ataturk State Hospital, Balikesir, Turkey
|Date of Submission||21-Jul-2016|
|Date of Acceptance||05-Dec-2016|
|Date of Web Publication||15-Feb-2017|
Balikesir Ataturk State Hospital General Surgery Department, Balikesir, 10100
Source of Support: None, Conflict of Interest: None
A 54-year-old woman presented at the emergency service with acute gastrointestinal bleeding. Her haemoglobin level was 6.5 mg/dl and she had hypovolemic shock symptoms. Emergency endoscopy showed a severely bleeding area near the cardia but no open vessel was visualized. As the bleeding could not be stopped by endoscopic intervention and another nonbleeding multiple erosive focus was seen close to the pylorus laparotomy, total gastrectomy was performed. The patient was discharged on postoperative day 6 without any complication. Interestingly, the pathologic examination of the bleeding lesion revealed a granulomatous inflammation. Additional searches to determine the source of the granulomatous inflammation (tuberculosis, Helicobacter pylori, Crohn’s disease, etc.) yielded negative results; hence, the case was classified as idiopathic granulomatous gastritis.
Keywords: bleeding, gastritis, granulomatous, idiopathic
|How to cite this article:|
Gures N, Erol M. Idiopathic granulomatous gastritis with severe gastrointestinal bleeding. Al-Azhar Assiut Med J 2016;14:146-7
| Introduction|| |
Gastritis can be classified as infectious, noninfectious, and idiopathic . First described by Fahimi et al. , idiopathic granulomatous gastritis (IGG) is a rare condition. Tuberculosis, syphilis, and mycosis can be infectious; sarcoidosis, Crohn’s disease, vasculitis, some malignancies, and foreign bodies can be noninfectious reasons of granulomatous lesions , To confirm IGG, infectious and noninfectious etiologies should be excluded .
Acute gastrointestinal bleeding is a life-threatening condition with high mortality and morbidity . Here, we would like to present an extremely rare case of acute gastrointestinal bleeding due to IGG.
| Case report|| |
A 54-year-old woman complaining of haematemesis, fatigue and dizziness was referred to the emergency department. She had no particular complaints other than hypertension and some vague gastrointestinal symptoms in anamnesis. The patient’s blood pressure was 70/30 mmHg and haemoglobin level was 6.5 mg/dl. Emergency room ultrasonography revealed nothing. After starting fluid and blood resuscitation the patient was taken to the endoscopy unit. On endoscopy, a bleeding, ulcerous and nodular 2×2 cm lesion neighbouring the cardia was seen, but haemostasis attempts failed. In addition, multiple erosive lesions were viewed in the antrum. The endoscope hardly passed to the bulbus duodeni. Open laparotomy was decided to be performed. On the basis of the multiple erosions in the antrum and suspicion of pyloric stricture in addition to the bleeding ulcer in the cardia, total gastrectomy was decided. The patient was discharged on postoperative day six without any complication.
Pathologic examination of the specimen revealed granuloma formations ([Figure 1] and [Figure 2]) in the different parts of the gastric mucosa, including the main bleeding lesion. A narrowed gastric outlet was also seen ([Figure 3]).
After recovery, the patient was investigated for other causes of granulomatous diseases. Infectious (including Helicobacter pylori) or noninfectious reasons were searched for and no aetiological factor could be identified. Thus, the case was regarded as IGG.
| Discussion|| |
A search of the scientific databases shows that IGG is a very rare disease. As most of the granulomatous lesions of the stomach are associated with systemic granulomatous diseases (sarcoidosis, Crohn’s disease, tuberculosis, vasculitis, etc.) or foreign bodies , careful examination is necessary. In fact, it was even questioned in the literature whether a disease could be classified as IGG . H. pylori is one of the main causes of gastric granulomas  but H. pylori was not detected in our patient’s tissues, although H. pylori is a common infectious agent worldwide and highly prevalent in the Turkish population .
Transmural, noncaseating granulomatous inflammation is the major histopathological feature of IGG . In our case, several noncaseating granulomatous lesions were observed in pathologic sections taken from different parts of the stomach. The main bleeding lesion was diagnosed as a granuloma as well. We did not encounter a case in the literature of an IGG with severe bleeding. Thus, this case can be regarded as an extremely rare example of gastrointestinal bleeding.
Pyloric narrowness was probably the result of granulomatous diseases; Spinzi et al.  reported a similar case of IGG with gastric outlet obstruction.
| Conclusion|| |
IGG should be contemplated as a rare cause of granulomatous lesions in the stomach. IGG may also be a reason for acute upper gastrointestinal bleeding.
Nazim Gures contributed in manuscript preparation, definition of intellectual content, literature search and clinical studies. Mustafa Erol contributed in manuscript preparation, literature search, clinical studies and data acquisition.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]