Fatal liver gas gangrene after biliary surgery

Miyata, Yui; Kashiwagi, Hirokazu; Koizumi, Kazuya; Kawachi, Jun; Kudo, Masatoshi; Teshima, Shin‐ichi; Isogai, Naoko; Miyake, Katsuhisa; Shimoyama, Rai; Fukai, Ryota; Ogino, Hitoshi

doi:10.1016/j.ijscr.2017.07.049

Cited by 4 publications

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References 11 publications

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“…The physicians treating the patients' should be consulted for the postmortem development or progression of subcutaneous emphysema, bullae, and the presence of localized organ symptoms, or if present imaging investigations such as computer tomography (CT) or abdominal ultrasound. 3,6,[8][9][10] The only somewhat specific gross change that can be considered in such cases is the presence of advanced parenchymal organ autolysis, while rigor mortis is still present. 5 Therefore the interpretation of these changes is difficult in autopsies which take place more than 48 hours after the patient has died.…”

Section: Discussionmentioning

confidence: 99%

Primary abdominal gas gangrene: a report of two autopsy cases

2021

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Primary hepatic gas gangrene is a form of primary abdominal gas gangrene. The condition is caused by Clostridium perfringens, other clostridia, and non-clostridia bacterial species producing gas. Unlike classical gas gangrene or myonecrosis, the disease develops without a wound or a port of entry. Instead, gas-producing bacteria in the gastrointestinal tract colonize an underlying pathological process with foci of necrosis, producing excessive gas and spreading hematogenously to other organs. Herein we present two autopsy cases of primary hepatic gas gangrene diagnosed on autopsy, with the gross and histological changes that can be considered specific for this rare condition. Both patients had severe underlying liver disease-prone for this entity development. The gross changes in the cases are postmortem subcutaneous emphysema, skin bullae with pooled blood, pneumothorax, pneumoabdomen, abundant gas in the circulatory system, porous structure of the internal organs (tissue gas bubbles), and advanced tissue lysis, not corresponding to the post mortem time. Histology showed optically empty areas of varying size in the internal organs, which weave the structure of the organs and rod-shaped bacteria with scarcity or complete absence of inflammatory reaction.

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Section: Discussionmentioning

confidence: 99%

Primary abdominal gas gangrene: a report of two autopsy cases

2021

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“…Since the first description of gas gangrene in an organ by Fraenkel in 1889, few cases of acute organ failure following acute Clostridium perfringens infection have been described in the literature [ 2 ]. Up to the middle of the last century, generalized gas gangrene was most often a consequence of soil-contaminated war wounds and was mostly lethal.…”

Section: Discussionmentioning

confidence: 99%

“…We reported previously a fatal case of gas gangrene of the liver and discussed the features of this dreadful disease on the basis of ten manuscripts reported in Ichushiweb in Japan from 1979 [ 2 ]. We concluded that history of malignant disease or an ischemic condition of the liver or neighboring organs may be crucial risk factors for liver gas gangrene.…”

Section: Discussionmentioning

confidence: 99%

“…To date, 16 cases have been reported in Japan [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. Table 2 shows the characteristics of the patients with liver gas gangrene, including our case.…”

Section: Discussionmentioning

confidence: 99%

“…It may be associated with clostridium or non-clostridium infection, although a clostridial cause has been reported in most cases. Recently, increasing numbers of non-clostridial cases have been reported [ 2 , 3 ]. Development of this dreadful disease is associated with host conditions such as malignancy and immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment of hepatic gas gangrene by open drainage: A case report and review of the Japanese literature

Ono

Kashiwagi

Kawachi

et al. 2018

International Journal of Surgery Case Reports

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Clostridium perfringensSepticemia and a Bleeding Ulcer of a Jejunal Interposition: A Case Report and Short Review of the Literature

Wild

Bormann

Sweiti

et al. 2018

Case Reports in Medicine

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Introduction We report a case of Clostridium perfringens septicemia in a patient presenting with a bleeding ulcer of a jejunal interposition. Case Presentation An 81-year-old female patient was acutely admitted to our hospital due to hematemesis and melena. She had a history of metastatic gastrointestinal stromal tumor, for which she was receiving second line treatment with sunitinib. She had also undergone a Merendino procedure 4 years prior to presentation. The patient underwent emergency gastroscopy, which revealed a bleeding ulcer in the jejunal interposition. Despite initial endoscopic control of the bleeding and transfusion of blood products, the hemoglobin level continued to drop, and the patient was treated for an assumed hemolytic transfusion reaction. The patient died 3 days following admission, and the results of blood cultures later confirmed a Clostridium perfringens septicemia. The postmortem examination revealed a diffuse spread of Clostridium perfringens to multiple organs. Conclusion This case is a reminder of the importance of considering septicemia, particularly in association with Clostridium perfringens, as a potential cause of hemolysis. It also demonstrates the extent of organ involvement in a case of diffuse clostridial myonecrosis.

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Fatal liver gas gangrene after biliary surgery

Cited by 4 publications

References 11 publications

Primary abdominal gas gangrene: a report of two autopsy cases

Primary abdominal gas gangrene: a report of two autopsy cases

Successful treatment of hepatic gas gangrene by open drainage: A case report and review of the Japanese literature

Clostridium perfringensSepticemia and a Bleeding Ulcer of a Jejunal Interposition: A Case Report and Short Review of the Literature

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