Non-traumatic gas gangrene in the abdomen: report of six autopsy cases

Abstract

Six autopsy cases of non-traumatic gas gangrene in the abdomen are reported. Five of the six were caused by clostridia, as identified by culture or histology. There were associated underlying diseases, such as alcoholism, liver cirrhosis, diabetes mellitus, and malignant disease. Three of the six patients had gas gangrene in the liver. Bacterial proliferation and gas accumulation were found in the sinusoids of the liver, and congestion and edema with extensive gas embolism were found in the lungs. Pulmonary gas embolism was considered to be the direct cause of death in these three patients. The other three patients had intestinal clostridial gas gangrene, with alcoholism as an underlying condition. None of the six patients was clinically diagnosed as having gas gangrene. We suggest that gas gangrene should be considered in any patient with abdominal infection. A review of 19 autopsy cases of gas gangrene in the abdomen reported in the Japanese literature is also presented.

Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case

“…Factors that favor traumatic gas gangrene are shock, presence of foreign bodies, and low redoxpotential in the wound [1]. Clostridial gas gangrene can also occur in the absence of trauma and is then associated with necrotic tissue, e.g., secondary carcinoma or acute pancreatitis, and general immune deficiency, e.g., liver cirrhosis, diabetes, or advanced neoplasm [2]. The overall prognosis is poor and depends on the evolution of septic shock.…”

Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases

“…The clinical course of gas gangrene is characterized by a rapid onset, aggressive progression, multiple organ failure, and high mortality rate [1,10,18,24,27]. Left untreated, the disease is almost always fatal, with death often occurring within hours after the onset of the first symptoms [1,5,8,14,22].…”

“…This type of gas gangrene has a strong association with severe underlying diseases and colorectal or hematological malignancies [1,7,10,13,18]. In addition, nontraumatic gas gangrene has also been described to occur in association with a variety of more or less debilitating disorders such as pancreatitis, cholezystitis, perforated duodenal ulcer, liver cirrhosis, diabetes mellitus, and alcohol abuse [1,8,11,14,18,24]. Here, nontraumatic gas gangrene originated from acute pancreatitis in two cases, and the disease was associated with von Willebrand's disease, diabetes mellitus, and chronic alcoholism in one case each.…”

“…Clostridium perfringens is the most common organism isolated from patients with gas gangrene [3,6]. Other Clostridium species identified as causative organisms of the disease include C. septicum, C. novyi, and C. sordellii [1,4,18,19,21,25,27].…”

Fatal Clostridium perfringens septicemia suggested by postmortem computed tomography: A medico-legal autopsy case report

“…The autopsy revealed a spongy and soft appearance of the liver 13 section, typically observed in clostridial gas gangrene cases [10]. The slight neutrophil 14 infiltration was observed only partly in the liver and adrenal gland tissue.…”