This is an example of an unfortunate gentleman who ingested battery acid. Note the acute mucosal necrosis.
There is severe hemorrhage which appears acute in nature in the lamina propria.
There is edema in the lamina propria as well which separates the glands. Note the most superficial epithelial layer is necrotic. The event is so acute that a dense inflammatory process has not even had time to set in.
Congested vessels and hemorrhage into the lamina propria can be seen.
Hemorrhagic gastritis or erosive gastritis results in abrupt onset of abdominal pain or bleeding. This acute gastric injury may be due to ingestion of a variety of substances (alcohol, NSAIDS, iron pills, steroids, crack cocaine) and may also be due to hypoperfusion, head injury (Cushing ulcer), severe burn (Curling ulcer) or sepsis (Iacobuzio).
Severe forms (corrosive gastritis) can result from acid caustic intake. Because of acid-induced coagulation injury, one of the major complications of corrosive injury is massive upper gastrointestinal bleeding (Ertekin).
On endoscopy, one may see gastric erosions or ulcers. Histologically, the severity of the picture depends the time interval between the gastritis and biopsy. Changes seen include subepithelial hemorrhage, hemorrhage into the lamina propria, edema, mucosal sloughing and necrosis (Cheng, Iacbuzio). Note that regenerative epithelium may exhibit alarming changes that simulate malignancy with dark nuclei with prominent nucleoli and back to back glands.
Presents with abdominal pain and hematemesis. Acute erosive/hemorrhagic gastritis should be considered in the differential on the patient with upper GI bleed. The bleeding can be minimal or life-threatening.
Treatment varies according to the severity and extent of the injury. Aggressive surgical intervention is necessary for more serious involvement.
Mortality is around 10% (Ertekin).
Cheng L, Bostwick DG, eds. Essentials of Anatomic Pathology. 2nd Ed. Totowa, NJ: Humana Press; 2006: 66-8.
Ertekin C, et al. The results of caustic ingestions. Hepatogastroenterology 2004 Sep-Oct;51(59):1397-400.
Iacobuzio-Donahue CA, Montgomery EA. Gastrointestinal and Liver Pathology: Foundations in Diagnostic Pathology. Philadelphia, PA: Elsevier; 2005: 66-9.