Gastric phycomycosis

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Abstract
Seven fatal cases of invasive gastric phycomycosis are reported. Four surgical patients presented with perforated gastroduodenal ulcer. Three medical cases were diagnosed at autopsy. Two surviving surgical cases are reported with non-invasive colonization of gastric ulcers, where operation was carried out for bleeding. When gastric phycomycosis presents as an invasive fungal infection the prognosis is extremely poor. Alternatively, the fungus may colonize the gastric mucosa without deeper invasion of the blood vessels, when the prognosis is good. A definite distinction between invasion and colonization can only be made histologically. Invasion should, however, be suspected at operation by the hardness of the tissues, their black discoloration and a hyperaemic zone between normal and abnormal areas. The fungus can invade the mucosa through a chronic gastric ulcer, when it usually occurs in relation to the lesser curvature. It is suggested that it may also gain access to the mucosa as a result of ulceration, occurring in the course of a debilitating disease. In this case the ulcer may occur anywhere within the stomach, and not infrequently multiple ulcers are present. The treatment of choice if the patient is fit is resection of the affected part of the stomach, as the basic lesion is tissue necrosis. Supportive treatment should include amphotericin B and antibiotics such as cephaloridine and gentamicin to control the associated bacterial infection which is often present.
Funding Information
  • Medical Research Council (M14/73/S1)

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