| A case of spontaneous clostridial myonecrosis developing shortly after diagnostic colonoscopy is described. The prime underlying factor proved to be an unsuspected colonic cancer, developing in a patient with pre-existing ulcerative colitis and sclerosing cholangitis. ( info) |
12/189. Small intestine perforation because of capacitive coupling as a cause of abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy. The authors present a case report regarding abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy. Capacitive coupling was considered to be the most probable cause of small intestine perforation and further complications. Despite intensive treatment, the 69-year-old patient died. ( info) |
| esophageal perforation and mediastinal gas gangrene developed in a 55-year-old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. Initially, extensive gangrene of the esophagus and the mediastinum was treated by esophagectomy; however, an abundance of clostridium perfringens in the Gram stain verified the presence of gas gangrene. Subsequently, the patient was transferred to a hyperbaric oxygen center, wherein a total of seven hyperbaric treatments were administered. The patient survived, and 4 months later, after having undergone several reoperations because of pleural empyema, mediastinal abscess, splenic rupture, and acalculous cholecystitis, was discharged and is still surviving. ( info) |
| clostridium septicum gas gangrene (myonecrosis) is an acutely painful and rapidly fatal infection occurring in the absence of trauma. Urgent surgery is essential both to control pain and to ensure survival. Most patients who develop this infection have an underlying malignancy and clinicians should be aware of this association. We present a case of bifocal myonecrosis which to our knowledge has not been reported previously. ( info) |
15/189. Two gas-gangrene-like infections due to bacillus cereus. Two cases of postoperative gas-gangrene-like infection due to bacillus cereus are reported, drawing attention to the fact that bacillus cereus, a common environmental bacterium, can occasionally give rise to severe post-operative infection. Characteristics of the organism related to the epidemiology and pathogenesis of such infections are discussed. ( info) |
| A 45-y-old man was hospitalized due to pain and swelling of the right leg for 3 d. Bullae developed with gas formation involving multiple compartments of the entire limb 46 h later. klebsiella pneumoniae was recovered from blood and surgical specimens. The patient died on Day 8 despite amputation and antibiotic therapy. ( info) |
17/189. Retroperitoneal gas gangrene complicating elective inguinal hernia repair. gas gangrene is a well recognised complication of contaminated military wounds. A case of Clostridial myonecrosis following elective inguinal hernia repair is described. The pathology, clinical features and management of this life-threatening condition are reviewed. ( info) |
| The progression of clostridium perfringens endomyometritis to gas gangrene is a rare, but greatly feared complication in the obstetrical patient. While endometritis following cesarean delivery is a common complication, recognition of C. perfringens as the pathogen as well as its progression to gas formation in the myometrium is essential to the survival of the patient. We present a patient that we recently cared for, and review the bacteriology, clinical diagnosis, and management. ( info) |
19/189. Common and uncommon infections of the hand. Most serious hand infections are preventable at this time if proper prophylaxis is maintained with regard to the hands and if the precursor conditions-mild inflammations and infections-are quickly and appropriately treated. In those few serious hand infections that still occur, a judicious combination of medical, surgical, and rehabilitative measures should preserve normal or at least reasonable function in practically all instances. ( info) |
| OBJECTIVE: To evaluate the results of treatment of nonclostridial gas gangrene at a Level 1 trauma center. DESIGN: Retrospective. SETTING: Level 1 trauma center. patients: Seven patients with nonclostridial gas gangrene were studied. The average age of all patients at the time of admission was 40.3 years (range 14 to 67 years). RESULTS: Three of seven patients had posttraumatic infection, and the remaining four were strongly associated with underlying diseases: diabetes mellitus in three and paraplegia as the result of a spinal cord injury in two. The time of symptom onset was clearly defined in four cases, and the average interval between symptom onset and transfer to our hospitals was six days (range 2 to 10 days). Surgical debridement was performed immediately on admission in six patients (86 percent). A triple antibiotic regimen consisting of penicillin, gentamicin, and clindamycin was used initially in all patients. In three patients, hyperbaric oxygen therapy was also used. The overall mortality rate was 42.9 percent (three of seven patients). In these patients, the interval from onset of symptom to transfer to our hospital was ten days in one patient, which was longer than average, and was not accurately known in the other two patients. CONCLUSION: Nonclostridial gas gangrene is extremely rare but life-threatening. The greatest pitfall for the emergency department physician is failure to suspect it clinically. Aggressive treatment, including surgical debridement and intravenous antibiotics with or without hyperbaric oxygen therapy, must be initiated immediately to minimize morbidity and mortality. ( info) |