An Unusual Fatal Outcome of Laparoscopic Cholecystectomy: A Case Report.

ABSTRACT

Clostridium perfringens (C. perfringens) and Klebsiella oxytoca (K. oxytoca) are pathogenic human bacteria. Clostridium perfringens sepsis with intravascular hemolysis is a catastrophic process with an extremely high mortality rate (70 to 100%). A 74-year-old male submitted to an elective laparoscopic cholecystectomy due to cholelithiasis and develops severe abdominal pain only 10 hours after being discharged from hospital. He was admitted to the emergency department with associated jaundice, fever, and hematuria. On arrival, his hemoglobin level was 9.2 g/dL but fell to 3.4g/dL within two hours. Massive intravascular hemolysis was diagnosed and a liver abscess with gas gangrene was shown in the contrast-enhanced computed tomographic. Despite proper management, a fatal outcome was unavoidable and the patient died eight ours later. Microbiological examination isolated C. perfringens and K. oxytoca. Liver abscesses caused by C. perfringens and K. oxytoca are extremely rare complications of laparoscopic cholecystectomy. Early recognition and prompt antibiotic therapy as well as control of septic focus are essential to minimize this fatal outcome.