Ruptured tuboovarian abscess and septic shock with Clostridium perfringens in a postmenopausal woman: a case report.

ABSTRACT

BACKGROUND: Clostridium perfringens is the most common causative organism of gas gangrene, a necrotizing infection of soft tissue classically associated with traumatic injuries. Recently, awareness of its occurrence in spontaneous nontraumatic contexts has been increasing. The authors report an unusual case of nontraumatic/spontaneous C perfringens gas gangrene localized to the adnexae. CASE A 55-year-old woman presented with abdominal complaints and had surgery because the computed tomographic finding of air in the abdomen led to a preoperative diagnosis of perforated bowel. An infected, draining, right tuboovarian complex and infected left tube were removed. The patient had a stormy postoperative course and was ultimately diagnosed with C perfringens infection/sepsis; she had to be readmitted over a month after discharge for drainage of a pelvic abscess, also due to clostridial infection. The patient ultimately underwent hysterectomy with removal of remaining adnexa. The hysterectomy specimen revealed endometrial carcinoma. CONCLUSION: C perfringens can cause adnexal infection in the absence of trauma. Diagnosis may be difficult. Timely, aggressive surgical and medical therapy is imperative. When such cases occur, malignancy should be suspected.