Bilateral gas gangrene of the hand - a unique case

Gas gangrene is a rare and rapidly progressive process with the propensity for devastating consequences. We report the first case of bilateral gas gangrene of the hand following bilateral middle phalangectomy of the middle fingers.

An Aeromonas veronii biovar sobria infection with disseminated intravascular gas production

We report a case of Aeromonas veronii biovar sobria infection with disseminated intravascular gas production. The patient was an afebrile 15-year-old girl who had been quite healthy until the onset of the illness. She came to the hospital because of a 6-h history of increasing pain and swelling in her left thigh. On admission, no infection was suspected, and a tentative diagnosis of a ruptured left gracilis muscle was made. Because the pain increased continuously, the treatment concentrated on pain control. Unexpectedly, abrupt death occurred 23 h after her admission. Postmortem computed tomographic (CT) scans showed an abundance of gas in the blood vessels of the entire body. Postmortem investigation revealed disseminated intravascular gas production, marked intravascular hemolysis, and numerous intravascular Gram-negative bacilli in all organs examined. The organisms were identified as A. veronii biovar sobria, and were highly susceptible to third-generation cephalosporins. Regarding therapeutic problems, the early administration of these antibiotics should reduce the fatality rate in such infections. It is critical to keep the possibility of such an infection in mind when a patient complains of severe muscle pain.

[The adverse effect of gas formation on prognosis in a patient with deep neck infection]

A seventy-one-year-old woman was hospitalized with a suspicion of deep neck infection and poor general health. She had been receiving treatment for hepatitis, diabetes mellitus, and cardiac failure and had a history of tooth ache and severe neck pain lasting for the past 10 days. She had been admitted to another center where she had received antibiotic treatment for five days for widespread swelling in the neck and lower extremities, fatigue, and difficulty in breathing and swallowing. Upon admission, computed tomography showed gas formation in the neck and facial regions. Prompt abscess drainage was performed and intense treatment with antibiotics was continued. Despite all efforts, the patient died on the second day of hospitalization from cardiopulmonary arrest. This case emphasizes how urgent drainage is when gas formation is detected in deep neck infections, with inevitable poor prognosis with antibiotic treatment alone.

Hyperbaric oxygen therapy in the treatment of orbital gas gangrene

Clostridial gas gangrene (myonecrosis) is a rapidly progressive, life-threatening infection. The occurrence of clostridial gas gangrene in the orbit is uncommon. We present a case of gas gangrene in the orbit of a child, with Clostridium perfringens isolated from the wound. Our patient was successfully treated with extensive surgical débridement, anti-microbial therapy, and hyperbaric oxygen therapy. Hyperbaric oxygen is established as an adjuvant therapy of clostridial gas gangrene and has been shown to significantly reduce morbidity and mortality. To our knowledge, this is the first reported case of using hyperbaric oxygen therapy in the treatment of orbital gas gangrene.

Spontaneous bifocal Clostridium septicum gas gangrene

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.

Gas. Radiographic indicator of infection

Gas is probably the best single radiographic indicator of infection in cattle, especially in and around the digits. With high quality images and a high-intensity light, gas may be detected in small pockets within the soft tissues, effacing bone surfaces, or within joints. This article illustrates the varied radiographic appearances of gas associated with infection, and the radiographic projections that optimize its detection.

Localized pneumocephalus caused by Clostridium perfringens meningitis

Clostridium meningitis is a rare complication of elective surgery, but the presence of pneumocephalus on CT in the absence of penetrating injuries, should raise the possibility of anaerobic infections. We report a case of fatal Clostridium perfringens meningitis which occurred 4 months after a craniotomy for glioblastoma multiforme. The diagnosis was suspected based on the CT findings. The literature of this rare condition is reviewed.

[Epidural gas aggregation in the course of gaseous degeneration of lumbar intervertebral disk as a cause of foot paresis]

The finding of gas within the vertebral disc space ("vacuum phenomenon") is relatively common. Degenerative spine disease, gaseous degeneration of the intervertebral disc, and epidural gas were disclosed on imaging study. The epidural gas could be attributed to gaseous disc degeneration. The nerve root in presented patient was compressed by epidural gas. Following surgery the clinical syndrome including foot drop has thoroughly resolved.

[Gas gangrene mediastinitis after Boerhaave syndrome]

Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the esophagus are both life threatening conditions. The combination of these two entities led to septic multiorgan failure in a 38-year-old woman. The patient was treated successfully by esophagectomy and postoperative lavage through a partially open abdomen. The lack of information regarding emesis, the leading symptom of Boerhaave's syndrome, caused delayed diagnosis: the triad of emesis, severe epigastric pain and emphysema of the skin was not established until 30 h after the onset of symptoms.

Nontraumatic subcutaneous emphysema in association with rectal carcinoma

Nontraumatic subcutaneous emphysema is a rare complication of colorectal cancer. To the authors' knowledge, only eight cases have been reported to date. The initiating event was free colonic perforation in seven of the patients and contained colosubcutaneous fistula in the eighth. In nontraumatic subcutaneous emphysema typical fecal flora is cultured, whereas in nontraumatic gas gangrene, a different clinical entity that has a fulminant course, the bacteria are generally clostridial. The authors report a case of nontraumatic subcutaneous emphysema associated with rectal carcinoma and describe the associated computed tomography findings.

CT of pancreatic gas gangrene

A case of gas gangrene complicating acute pancreatitis is presented. The presence of gas within the pancreatic bed is very suggestive of infection with gas forming organisms in the right clinical setting.