Spontaneous gas gangrene of the pancreas

A patient had gas gangrene due to spontaneous Clostridium perfringens infection of the pancreas. He had not undergone any invasive procedure. An initial laparotomy ruled out a suspected intestinal origin of his infection; lack of evidence of pancreatitis before his acute attack indicated that no superinfection was involved. We have found no other report of primary gas gangrene of the pancreas.

Gas gangrene from subcutaneous insulin administration

A case of gas gangrene that caused intractable shoulder pain refractory to narcotics in an immunocompromised host is presented. Gas gangrene has been associated with severe trauma involving penetrating wounds, compound fractures, extensive soft-tissue injury, intramuscular injection of epinephrine, and interruption of arterial blood supply. This case describes an elderly insulin-dependent diabetic woman who developed gas gangrene in her arm and leg at the site of her subcutaneous insulin injections. The responsible organism was Clostridium septicum. Emergency medicine physicians must consider gas gangrene Clostridium infection in immunocompromised individuals without evidence of trauma who present with localized and intractable pain.

Spontaneous clostridial myonecrosis with abdominal involvement in a nonimmunocompromised patient

Spontaneous clostridial myonecrosis is a rare but aggressive disease usually associated with underlying immunosuppression or malignancy. We present a fatal case of clostridial myonecrosis arising in a patient with intact immune defenses.

Gas-forming infections

A 89 year old woman was admitted with increasing confusion and difficulty in walking. Her left thigh was swollen, erythematous and had associated crepitus.

Gas gangrene following intra-arterial injection of oral medication in a drug abuser

We report a patient in whom intra-arterial injection of oral medication led to the development of fulminating gas gangrene and death, despite the initial clinical symptoms being minor. We believe that prophylactic antibiotics should be administered to patients following intra-arterial injection of oral medication especially if immunocompetence, such as from human immunodeficiency virus (HIV) infection, is likely.

Hepatic artery thrombosis resulting in gas gangrene of the transplanted liver

Early hepatic artery thrombosis after orthotopic liver transplantation results in massive injury to hepatocytes and the bile duct epithelium. In the fulminate form, impaired liver synthetic function is expressed by encephalopathy and coagulopathy. Ischemic bile duct injury is associated with the disruption of the biliary anastomosis, bile duct strictures, and intrahepatic bilomas. The inability of the liver macrophages to clear translocated portal blood intestinal pathogens results in persistent bacteremia and sepsis. The major radiologic finding is the radiographic evidence of gas gangrene of the liver graft. Early recognition and correct interpretation of the radiologic findings, immediate removal of the liver graft, and placement of the patient on venous-venous bypass or total hepatic devascularization while a new liver is being procured and retransplantation are the only hope for survival.

[Gas-forming infections of the extremities]

A variety of cases of gas-forming infections has been collected and the radiological appearances due to the gas formation are described. In the context of the clinical situation the development of gas gangrene can be distinguished from other gas-forming infections which are mostly due to B. coli or cellulitis due to anaerobic streptococci. In addition to describing the pathology and clinical course, the possible forms of treatment are discussed.

Sonographic demonstration of septicaemia with gas-forming organisms after liver transplantation

Sepsis with gas-forming organisms, e.g. Clostridium perfringens and anaerobic streptococci occurred in three of 120 liver-transplant recipients (2.5%). The diagnosis was made in all three patients by bedside ultrasound, before blood cultures revealed bacterial growth. Floating high amplitude echoes within the extra- and intrahepatic portal veins and persistent small high amplitude echoes in the non-dependent portion of the liver are indicative of portal venous gas and should prompt further laboratory investigations.

Gas gangrene: a cautionary tale

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Sucking wound of the knee: not gas gangrene

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[Gas gangrene disclosing colonic cancer. Role of synergistic gangrene]

After reporting a case of synergistic gas gangrene of the retroperitoneum spreading to the thigh, revealing a carcinoma of the descending colon, the authors review the symptomatology and management of synergistic gas gangrene defined as a gas gangrene due to anaerobic non clostridial bacilli, and aerobic flora and emphasize the exceptional nature of its association with a carcinoma of the colon.

Usefulness of computerized tomography in evaluating necrotizing fasciitis

A 54-year-old man was seen with what appeared to be cellulitis of the left lower extremity. Roentgenograms showed no evidence of gas in soft tissues. Two days later films revealed gas in soft tissues of the leg, but not in the thigh. Computerized tomography showed pockets of gas in the lateral fascial planes of both leg and thigh. Surgical exploration revealed extensive necrotizing fasciitis. CT scanning provided a much more accurate picture of the extent of infection than did standard radiographs.

"Cold spot" imaging with gas gangrene in three phase skeletal scintigraphy

A photon deficient "cold spot" was noted in all three phases of a three phase bone study in a patient with gas gangrene of the foot. The scintigraphic findings correlated with the area of soft tissue gas noted in radiographs.

[Tomodensitometry of severe acute pancreatitis]

90 computed tomographic examinations were performed to 57 patients referred at Hospital Saint-Louis for an acute pancreatitis. 32 patients were operated or autopsied. Among these 32 patients, 19 patients had 21 examinations before surgery or autopsy; the other 13 patients had their computed tomographic examinations after one or more surgical procedures. During a severe acute pancreatitis the pancreas is always large either locally or diffusely. A pancreatic reaction is visible around and possibly at distance of the pancreas. When extraluminal gas is visible (3/5) it signifies gangrenous pancreatitis but it is necessary to eliminate a digestive fistulous tract and/or a communication between a pseudocyst and the digestive tract. Except gangrenous it is not possible to precise the nature of pancreatic reaction. The diagnosis of pseudocyst was easy 9/10, difficult 1/10; we did a false positive diagnosis of pseudocyst. Computed tomography and ultrasounds were compared in ten patients for the search of gallbladder lithiasis. Computed tomography can show large and small (2/4) biliary calculus in the gallbladder that cannot be shown by ultrasounds. A normal pancreas in a normal retroperitoneal space exclude the diagnosis of a severe acute pancreatitis. CT aspects of acute pancreatitis must be considered as a good diagnostic test of an acute pancreatitis.

Xeroradiography of the diabetic foot

The authors carried out comparative xeroradiographic and radiologic examinations of 34 patients suffering from diabetes. It has been established that xeroradiography allows an earlier and more convincing diagnosis of arterial calcifications, indurations of small size arteries, phleboliths and fistulous tracts. In diabetic gangrene the initial lesions and bone sequestra are more clearly visualized, as well as the intra-articular bone fragments and parosteal calcifications in diabetic osteoarthropathy.