PMC4359583_01
Radiologic findings. a. Plain abdominal X-ray showing a markedly dilated stomach b. Contrast CT-scan showing a significantly distended stomach with thickened wall and abnormal configuration. Note also air-fluid level.
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Fig1
Plain abdominal X-ray showed a markedly dilated stomach (Figure 1a). Contrast CT-scan, performed to rule out an organic cause for the gastric outlet obstruction, showed a significantly distended stomach with thickened wall and abnormal configuration, and a single air-fluid level (Figure 1b).
Gastroscopy. Deformed stomach, with rotation like appearance. There are inflamed areas with greenish brown material over the surface.
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Fig2
Two gastroscopies were then performed, 1 week apart, and revealed a deformed stomach with a hard mass infiltrating the greater curvature in the fundic area, covered by necrotic greenish brown material, along with absent peristaltic movement and no apparent organic obstruction to the gastric outlet (Figure 2).
Gastroscopic biopsies. a. Inflamed atrophic mucosa with dilated foveolae and pigmented fibrinopurulent inflammatory exudate. H & E x 100 b. Perl's stain showing iron negative brownish pigment. x 400.
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Fig3
Histologic examination showed an actively inflamed, focally ulcerated, atrophic fundic mucosa with variable, focal eosinophilic infiltration, edema, and variably dilated foveolae with focal regenerative epithelial atypia (Figure 3).
Filamentous and rod-like bacteria consistent with
Actinomyces
in gastroscopic biopsies. a. H & E x 400 b. PAS x 1000 c. Gram x 1000 d. Grocott's x 1000.
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Fig4
There were also fragments of a fibrinopurulent exudate mixed with brownish, iron negative pigment (Perl's stain) and abundant PAS, Grocott's, and Gram positive rod-like and filamentous bacteria, morphologically consistent with Actinomyces (Figure 4).