Severe septic cholangitis and pancreatitis withClostridium perfringens: a rare but fatal complication after ERCP

Abstract

This case describes a patient treated with elective repeat endoscopic retrograde cholangiopancreatography (Re-ERCP). In the subsequent postinterventional course, the patient developed severe abdominal pain, followed by a rapid deterioration in the overall condition, resulting in circulatory instability. Despite the immediate initiation of antibiotic therapy, the patient’s general condition deteriorated progressively with persisting catecholamine dependency, escalating lactic acidosis and radiologic identification of air within the pancreas parenchyma and the splenic vein as well as along the surrounding tissues, leading ultimately to the patient’s death.Postmortem,Clostridium perfringenswas detected within the pancreatic parenchyma and blood cultures, establishing the diagnosis of post-ERCP pancreatitis complicated by severeC. perfringenscholangiosepsis.One of many possible pathogens of cholangitis, a rare but serious complication of ERCP, isC. perfringens. Infections due toC. perfringensshow evidence of tissue necrosis, bacteraemia, emphysematous cholecystitis and gas gangrene, also known as clostridial myonecrosis.