RESUMEN
AIM: Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of abdominal surgery or liver transplantation. We report a case of GG of the liver occurred after percutaneous microwave (MW) ablation of an hepatocellular carcinoma (HCC) successfully treated with percutaneous Radiofrequency ablation (RFA). CASE PRESENTATION: A 76-year-old female patient was treated with MW ablation for a large HCC in the VIII segment; 2 days later she developed fever, weakness, abdominal swelling and was hospitalized with diagnosis of anaerobic liver abscess. Despite antibiotic therapy, the patient conditions worsened, and she was moved to the intensive care unit (ICU). Percutaneous drainage was attempted, but was unsuccessful. The surgeon and the anesthesiologist excluded any indication of surgical resection. We performed RFA of the GG by 3 cool-tip needles into the infected area. The procedure was well tolerated by the patient, who left the hospital for follow-up. CONCLUSION: Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients refractory to antibiotics and when surgery and OLT are not feasible. A fast and early indication is needed in case of rapid worsening of the patient's conditions.
Asunto(s)
Carcinoma Hepatocelular , Gangrena Gaseosa , Neoplasias Hepáticas , Microondas , Ablación por Radiofrecuencia , Humanos , Anciano , Femenino , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/complicaciones , Microondas/uso terapéutico , Ablación por Radiofrecuencia/métodos , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/terapia , Terapia Recuperativa/métodos , Hígado/diagnóstico por imagen , Hígado/cirugíaRESUMEN
We present the case of a 57-year-old male patient with a fatal outcome after resection of a soft tissue sarcoma of the lateral thigh. A polymicrobial surgical site infection with Staphylococcus lugdunensis and Clostridium perfringens caused fulminant necrotising fasciitis with an additional gas gangrene. The patient suffered a severe sepsis with consecutive haemolysis and multiorgan failure. The authors recapitulate the deadly progress of a rarely reported complication after oncological resection. The therapeutic approach and surgical interventions are discussed based on the current literature.
Asunto(s)
Infecciones por Clostridium , Fascitis Necrotizante , Gangrena Gaseosa , Sarcoma , Neoplasias de los Tejidos Blandos , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/cirugía , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/etiología , Fascitis Necrotizante/cirugía , Resultado Fatal , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/etiología , Humanos , Masculino , Persona de Mediana Edad , Sarcoma/cirugía , Muslo/cirugíaAsunto(s)
Infecciones por Clostridium/diagnóstico por imagen , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/patología , Pierna/microbiología , Adolescente , Amputación Quirúrgica , Clostridium/aislamiento & purificación , Clostridium/patogenicidad , Gangrena Gaseosa/microbiología , Técnicas Histológicas/métodos , Humanos , Pierna/patología , Pierna/cirugía , Patología/métodos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.
Asunto(s)
Enfisema/diagnóstico por imagen , Gases , Tomografía Computarizada por Rayos X , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/microbiología , Absceso/diagnóstico por imagen , Absceso/microbiología , Aortitis/diagnóstico por imagen , Aortitis/microbiología , Cistitis/diagnóstico por imagen , Cistitis/microbiología , Enfisema/microbiología , Colecistitis Enfisematosa/diagnóstico por imagen , Colecistitis Enfisematosa/microbiología , Femenino , Gangrena de Fournier/diagnóstico por imagen , Gangrena de Fournier/microbiología , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/microbiología , Gastritis/diagnóstico por imagen , Gastritis/microbiología , Hepatitis/diagnóstico por imagen , Hepatitis/microbiología , Humanos , Masculino , Pancreatitis/diagnóstico por imagen , Pancreatitis/microbiología , Enfermedades de la Próstata/diagnóstico por imagen , Enfermedades de la Próstata/microbiología , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/microbiología , Pielitis/diagnóstico por imagen , Pielitis/microbiología , Pielonefritis/diagnóstico por imagen , Pielonefritis/microbiología , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/microbiologíaRESUMEN
Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.
Asunto(s)
Aorta/diagnóstico por imagen , Gangrena Gaseosa/diagnóstico por imagen , Diálisis Renal/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Anciano , Reanimación Cardiopulmonar/efectos adversos , Clostridium/aislamiento & purificación , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/microbiología , Muerte Súbita/etiología , Diagnóstico , Gangrena Gaseosa/microbiología , Humanos , MasculinoRESUMEN
Cellulitis accompanied by gas gangrene is a rapidly-spreading and potentially fatal infection. Here, we present a case of gas gangrene in the deep spaces of the head and neck in an elderly woman, diagnosed by computed tomography (CT). An 86-year-old woman with Alzheimer's disease, hypertension, hyperlipidemia, and osteoporosis was referred to our institute by her local dentist. The patient exhibited trismus caused by severe swelling in the left submandibular area. CT images of the head and neck area showed swelling of the cervical tissue with air in the parapharyngeal and masticator spaces. She was treated with antibiotics, followed by drainage. Although the therapy was continued, the patient died from a cardiac complication on hospital day 42. Our case highlights the usefulness of CT for diagnosing gas gangrene in the deep spaces of the head and neck in a woman with Alzheimer's disease.
Asunto(s)
Gangrena Gaseosa , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Celulitis (Flemón)/diagnóstico por imagen , Femenino , Gangrena Gaseosa/diagnóstico por imagen , Humanos , Boca/diagnóstico por imagenRESUMEN
BACKGROUND: Gas gangrene is an invasive, fatal anaerobic infection that is characterized by acute, rapid evolution and high mortality. Gas gangrene is often secondary to open fractures with deep wounds but is extremely rare in the patients undergoing elective surgery. Implant removal is a common elective operation in orthopedics after the union of fractures, and the complications of this surgery include infection, nerve injury and re-fracture. However, to the knowledge of the authors, there is no report in the literature on gas gangrene following implant removal. Here, we present a case study of gas gangrene following the removal of an internal fixation device after the union of a tibial plateau fracture. CASE PRESENTATION: A 59-year-old man with a postoperative union of a left tibial plateau fracture after open reduction and internal fixation complained of severe pain in the wound region on the first morning after implant removal surgery, and the incision was severely swollen and filled with hemorrhagic content. On the second morning, the patient's symptoms were aggravated progressively. The patient experienced delirium on the third morning after surgery, and a physical examination revealed subcutaneous crepitus extending along the length of the limb, and roentgenograms revealed the accumulation of gas in soft tissue. Gas gangrene was highly suspected, and the left femoral amputation was performed the following night at approximately 11 p.m. General supportive therapy and antibiotic therapy were given subsequently, and the patient was recovered and discharged after his vital signs were stable. CONCLUSIONS: Although gas gangrene is rare, its high mortality and disability indicate that we should pay attention to its prophylaxis, and strict aseptic techniques should be emphasized for even the most minor procedure.
Asunto(s)
Remoción de Dispositivos/efectos adversos , Fijación Interna de Fracturas/instrumentación , Gangrena Gaseosa/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Fijación Interna de Fracturas/efectos adversos , Gangrena Gaseosa/etiología , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis/efectos adversos , Infecciones Relacionadas con Prótesis/etiologíaRESUMEN
In this case report, a 40-year-old woman with a history of a uterine leiomyoma presented with abdominal pain and fever. Initially, her symptoms were associated with a bleeding from an ovarian cyst seen on a CT scan of the abdomen showing free intraperitoneal fluid surrounding the internal genitals. Meanwhile, her blood cultures came out positive for Clostridium perfringens, and her condition deteriorated despite intravenous antibiotics. A new CT scan revealed intrauterine gas development. A laparotomy was performed with removal of the internal genitals, and the patient improved on continuous antibiotics.
Asunto(s)
Clostridium perfringens/aislamiento & purificación , Gangrena Gaseosa , Enfermedades Uterinas , Adulto , Antibacterianos/uso terapéutico , Femenino , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/tratamiento farmacológico , Gangrena Gaseosa/microbiología , Gangrena Gaseosa/cirugía , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/microbiología , Tomografía Computarizada por Rayos X , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/tratamiento farmacológico , Enfermedades Uterinas/microbiología , Enfermedades Uterinas/cirugía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/microbiologíaRESUMEN
A 66-year-old man with poorly controlled type 2 diabetes was admitted for acute bilateral calf pain in the context of coronary artery disease, chronic renal failure, and peripheral neuropathy. Lower-extremity Doppler ultrasound excluded deep vein thrombosis. FDG-PET was performed to exclude a suspected infection because of elevated white blood cells and inflammatory markers but normal creatinine kinase levels. PET scan demonstrated intense bilateral calf muscle and left thigh muscle uptake, which in combination with the patient's history was consistent with diabetic myonecrosis, a rare end-stage complication of diabetes. The patient was managed conservatively, and pain resolved following a typical self-limited course.
Asunto(s)
Complicaciones de la Diabetes/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Gangrena Gaseosa/diagnóstico por imagen , Tomografía de Emisión de Positrones , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Humanos , MasculinoRESUMEN
BACKGROUND: Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION: A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys. Antibiotics were initiated followed by emergency surgery for source control of the infection. However, owing to his poor condition and septic shock, aortic repair was not possible. We performed bilateral nephrectomy as a possible source control, after which we initiated mechanical ventilation, continuous hemodialysis, and hemoperfusion. A culture of the samples taken from the infected region and four consecutive blood cultures yielded C. septicum. His condition gradually improved postoperatively; however, on postoperative day 10, massive hemorrhage due to aortic rupture resulted in his death. CONCLUSIONS: In this patient, C. septicum was thought to have entered his blood through a gastrointestinal tumor, infected the aorta, and spread to his kidneys. However, we were uncertain whether there was an associated malignancy. A literature review of C. septicum-related aneurysms revealed the following: 6-month mortality, 79.5%; periaortic gas present in 92.6% of cases; no standard operative procedure and no guidelines for antimicrobial administration established; and C. septicum was associated with cancer in 82.5% of cases. Thus, we advocate for early diagnosis via the identification of periaortic gas, as an aortic aneurysm progresses rapidly. To reduce the risk of reinfection as well as infection of other sites, there is the need for concurrent surgical management of the aneurysm and any associated malignancy. We recommend debridement of the infectious focus and in situ vascular graft with omental coverage. Postoperatively, orally administered antibiotics must be continued indefinitely (chronic suppression therapy). We believe that these treatments will decrease mortality due to C. septicum-infected aortic aneurysms.
Asunto(s)
Aneurisma Infectado/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Gangrena Gaseosa/diagnóstico por imagen , Aneurisma Infectado/complicaciones , Aneurisma de la Aorta Abdominal/complicaciones , Rotura de la Aorta , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/diagnóstico por imagen , Infecciones por Clostridium/cirugía , Clostridium septicum , Diagnóstico Precoz , Resultado Fatal , Gangrena Gaseosa/complicaciones , Gangrena Gaseosa/cirugía , Humanos , Infarto/complicaciones , Infarto/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nefrectomía , Isquemia de la Médula Espinal/complicaciones , Isquemia de la Médula Espinal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Inflammatory markers are essential tools in the decision-making process for lower extremity infections. When coupled with objective findings, clinicians can more accurately diagnose and treat these entities. Typically, markers such as the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are used to initially assess these patients or monitor the progression of medical or surgical therapy. Procalcitonin is a newer inflammatory marker that is specific for an infectious process. Originally, procalcitonin was used to monitor antibiotic therapy and sepsis for patients in the intensive care setting, but it has now been expanded to other facets of medicine. The utility of procalcitonin has been described for diagnosing infection or osteomyelitis in diabetic foot ulcers. However, limited research has compared inflammatory marker levels and the level of amputation. A retrospective inpatient medical record review was performed of 156 consecutive patient occurrences during 25 months in which surgical intervention was required for a lower extremity infection and an initial procalcitonin level had been obtained. This initial procalcitonin value was then compared with the level of amputation at the final surgical intervention. A highly statistically significant difference was found when comparing those who underwent a below-the-knee or above-the-knee amputation (median procalcitonin 1.72 ng/mL) and those who did not (median procalcitonin 0.105 ng/mL; p < .001). Therefore, patients with higher initial procalcitonin values were more likely to undergo below-the-knee or above-the-knee amputation or require aggressive surgical intervention. Thus, the procalcitonin level can provide valuable initial information to the clinician.
Asunto(s)
Amputación Quirúrgica , Infecciones Bacterianas/sangre , Calcitonina/sangre , Pie Diabético/sangre , Gangrena Gaseosa/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/etiología , Infecciones Bacterianas/cirugía , Biomarcadores/sangre , Pie Diabético/complicaciones , Pie Diabético/diagnóstico por imagen , Femenino , Pie/diagnóstico por imagen , Gangrena/etiología , Gangrena/cirugía , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/etiología , Humanos , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Adulto JovenAsunto(s)
Adenocarcinoma/secundario , Carcinoma Neuroendocrino/secundario , Neoplasias del Ciego/patología , Clostridium septicum/aislamiento & purificación , Fascitis Necrotizante/microbiología , Gangrena Gaseosa/microbiología , Adenocarcinoma/terapia , Anciano , Biopsia , Carcinoma Neuroendocrino/terapia , Neoplasias del Ciego/terapia , Colonoscopía , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/terapia , Cuidados Paliativos al Final de la Vida , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To report a case of gas gangrene in a fetus at term, which was diagnosed by antenatal computed tomography (CT) imaging. CASE REPORT: A 23-year-old primiparous woman, who did not undergo any prenatal health checks until term, developed hypertension, proteinuria, and clouding of consciousness, and experienced intrauterine fetal death. A single, mature fetus with voluminous gas bubbles was observed on CT, which was consistent with a diagnosis of fetal gas gangrene. Following the induction of labor, a dead, malodorous infant was delivered, along with foul-smelling and frothy amniotic fluid. The patient's condition deteriorated, and intensive care support was required to treat the patient for septic shock and disseminated intravascular coagulation during the postpartum period. She died on the 2(nd) postpartum day. CONCLUSION: Fetal gas gangrene is a very rare and potentially lethal event in pregnant women. To our knowledge, this is the first report on the antenatal diagnosis of fetal gas gangrene in a term pregnancy through CT. CT was useful for evaluating the extent of emphysematous change in the fetal and maternal organs.
Asunto(s)
Enfermedades Fetales/diagnóstico por imagen , Gangrena Gaseosa/diagnóstico por imagen , Muerte Perinatal/etiología , Tomografía Computarizada por Rayos X , Resultado Fatal , Femenino , Gangrena Gaseosa/embriología , Humanos , Recién Nacido , Embarazo , Mortinato , Adulto JovenAsunto(s)
Gangrena Gaseosa/diagnóstico por imagen , Enfermedad Aguda , Anciano , Clostridium perfringens/aislamiento & purificación , Resultado Fatal , Gangrena Gaseosa/patología , Hematuria/etiología , Humanos , Masculino , Espacio Retroperitoneal/diagnóstico por imagen , Muslo/diagnóstico por imagenRESUMEN
BACKGROUND: Clostridium septicum (C. septicum) aortitis is a rare but highly fatal infection that has a strong association with occult malignancy. Aneurysmal transformation of C. septicum aortitis is common and has been reported to occur in as little as 1 to 3 weeks. We report a case of C. septicum Aortitis with concomitant adenocarcinoma of the ascending colon detected via CT scan. Imaging findings of colonic malignancy with aortitis are highly suggestive of infection with C. septicum. Given the high associated mortality and rapid progression, early recognition on imaging could have life saving implications. Additionally, imaging findings of aortitis in conjunction with C. septicum bacteremia should prompt the careful evaluation for malignancy, most notably colonic or hematologic.
Asunto(s)
Adenocarcinoma/complicaciones , Aortitis/microbiología , Clostridium septicum/aislamiento & purificación , Neoplasias del Colon/complicaciones , Gangrena Gaseosa/microbiología , Adenocarcinoma/diagnóstico por imagen , Anciano , Aortitis/diagnóstico por imagen , Aortitis/cirugía , Aortografía/métodos , Neoplasias del Colon/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/cirugía , Humanos , MasculinoAsunto(s)
Gangrena Gaseosa/complicaciones , Perforación Intestinal/complicaciones , Enfermedades Musculares/etiología , Enfermedades Musculares/patología , Necrosis/etiología , Necrosis/patología , Clostridium septicum , Colectomía , Desbridamiento , Femenino , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/cirugía , Humanos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Persona de Mediana Edad , Enfermedades Musculares/cirugía , Necrosis/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Diabetes Mellitus/microbiología , Infecciones por Escherichia coli/diagnóstico por imagen , Escherichia coli/aislamiento & purificación , Gangrena Gaseosa/diagnóstico por imagen , Pierna/diagnóstico por imagen , Anciano , Desbridamiento , Diabetes Mellitus/inmunología , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/cirugía , Gangrena Gaseosa/microbiología , Gangrena Gaseosa/cirugía , Humanos , Huésped Inmunocomprometido , Pierna/microbiología , Pierna/cirugía , Masculino , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
We report a fatal case of suspected Clostridium (Cl.) perfringens septicemia in a previously healthy woman in her eighties. At first, she presented at the hospital complaining of upper abdominal discomfort and vomiting, and was discharged the next day after ruling out any fatal conditions. However, her condition deteriorated approximately 10h after discharge and she died shortly after. The postmortem computed tomography (PMCT) performed 29h postmortem revealed an excessive systemic gas accumulation compared with the postmortem external appearance and time elapsed since her death, which suggested the presence of a gas-forming infection. Histopathological examination showed diffuse proliferation of Gram-positive bacilli in almost all the organ tissues, especially in blood vessels. Along with these findings, hyperthermia 3h postmortem, and severe anemia and thrombocytopenia without an obvious site of hemorrhage suggested hemolysis due to Cl. perfringens septicemia. These findings suggested the diagnosis before performing the conventional autopsy. To the best of our knowledge, this is the first case report to describe PMCT findings of gas-forming infection and septicemia in contrast with the external appearance and histopathological findings in a medico-legal autopsy setting.