Death from Clostridium welchii infection is usually the result of toxaemia. Invasion of the blood stream is uncommon in man, except in cases of induced abortion or as a preagonal bacteraemia. The purpose of this paper is to report a case of fatal infection by this organism after partial gastrectomy.Case Report J.W., aged 38, a male office worker, was admitted on November 28, 1954, with a i6-year history of indigestion. A diagnosis of chronic duodenal ulcer with gross pyloric obstruction was confirmed radiologically. On January 6, 1955, partial gastrectomy was performed. There was a grossly scarred ulcer in the first part of the duodenum, causing marked stenosis; considerable induration of the adjacent area of the pancreas existed and mobilization of the ulcer was not attempted. The pyloric antrum was transected about i in. proximal to the pylorus. Approximately two-thirds of the stomach was removed and an antecolic anastomosis performed.The Ryle's tube was removed after the second day and the patient was taking 3 oz. water every hour. Four days after operation he began vomiting during the night and the pulse rate rose to I04, the temperature remaining at 980F. He was given 3 oz. milk and water every hour. By January i i the temperature had risen to io00, and the pulse rate was I20. The abdomen was grossly distended, the patient being cyanosed and restless. A diagnosis of acute pancreatitis was considered and a serum amylase estimation was 240 Somogyi units (normal 70 to I50 units). Laparotomy was performed, but no leakage or evidence of infection was found, and the wound was closed. The next day his condition had deteriorated and he died.Necropsy was carried out 27 hours after death, the body having been removed to the refrigerated mortuary after four hours. The body was that of a well-built male. There was a recent upper midline abdominal incision closed by separate sutures and clips, with a tube emerging from the upper end. The neck was red and swollen and crepitated.The upper respiratory tract was very red; there was pus in the epiglottis. The lungs were very oedematous, the right weighing 850 g. and the left 590 g. The lower lobes were congested with blood and there were large scattered petechial haemorrhages over the pleural surfaces. Haemorrhages were also present along the posterior atrioventricular groove of the heart.The peritoneal cavity contained a moderate amount of yellow fluid and fibrinous exudate. The wound surfaces did not show any obvious gas gangrene. The oesophagus was congested and the stomach was full of a rather purulent fluid. The sites of anastomosis were intact. There were two oval ulcers about i cm. in diameter in the duodenal stump. It was difficult to determine whether there had been any leakage at this point. All the intestines were dilated. There was no blood or evidence of ulceration in the bowel.The liver was a pale terra-cotta colour with a fibrinous exudate over the diaphragmatic surface. There were numerous honeycombed gas bubbles present, especially involving the left lobe. Th...
