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Stoyanov GS, Dzhenkov DL, Petkova L. Primary abdominal gas gangrene: a report of two autopsy cases. AUTOPSY AND CASE REPORTS 2021; 11:e2021329. [PMID: 34604123 PMCID: PMC8478362 DOI: 10.4322/acr.2021.329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022] Open
Abstract
Primary hepatic gas gangrene is a form of primary abdominal gas gangrene. The condition is caused by Clostridium perfringens, other clostridia, and non-clostridia bacterial species producing gas. Unlike classical gas gangrene or myonecrosis, the disease develops without a wound or a port of entry. Instead, gas-producing bacteria in the gastrointestinal tract colonize an underlying pathological process with foci of necrosis, producing excessive gas and spreading hematogenously to other organs. Herein we present two autopsy cases of primary hepatic gas gangrene diagnosed on autopsy, with the gross and histological changes that can be considered specific for this rare condition. Both patients had severe underlying liver disease-prone for this entity development. The gross changes in the cases are postmortem subcutaneous emphysema, skin bullae with pooled blood, pneumothorax, pneumoabdomen, abundant gas in the circulatory system, porous structure of the internal organs (tissue gas bubbles), and advanced tissue lysis, not corresponding to the post mortem time. Histology showed optically empty areas of varying size in the internal organs, which weave the structure of the organs and rod-shaped bacteria with scarcity or complete absence of inflammatory reaction.
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Affiliation(s)
- George S Stoyanov
- Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
| | - Deyan L Dzhenkov
- Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
| | - Lilyana Petkova
- Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
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Tariq H, Kamal MU, Makker J, Azam S, Pirzada UA, Mehak V, Kumar K, Patel H. Hepatitis in slaughterhouse workers. World J Hepatol 2019; 11:37-49. [PMID: 30705717 PMCID: PMC6354121 DOI: 10.4254/wjh.v11.i1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/03/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Slaughterhouse workers (SHW) are at increased risk of hepatitis which can occur due to different organisms and should be investigated for viral, bacterial, and parasitic organisms. Slaughter house personnel including butchers are at a higher risk of infections from cuts and blood-letting, with the possible risk of the transmission of blood-borne pathogens to their colleagues. The objective of this review is to evaluate the common etiologies of hepatitis in SHW which will assist in the assessment of these patients presenting with transaminitis. Types of Microorganisms causing hepatitis with their reservoirs, routes of transmission, laboratory diagnosis, clinical features, treatment options and preventive strategies are included in this review. Proper investigation and awareness is of utmost importance as it causes significant financial constraints derived from workers health cost and from livestock production losses when the disease is confirmed. The work up is essential because infected workers might be a source of infections to other colleagues, family and the consumers.
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Affiliation(s)
- Hassan Tariq
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Muhammad Umar Kamal
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Sara Azam
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Usman Ali Pirzada
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Vaniza Mehak
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Kishore Kumar
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Harish Patel
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
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Abstract
Objective To describe a case of emphysematous hepatitis which is a rare clinical entity, characterized by a fatal, rapidly progressive infection of the liver with a radiological appearance simulating emphysematous pyelonephritis and to help provide more data about the causative organisms and precipitating factors of this pathology. Data Sources and Synthesis Relevant literature was reviewed and, to the best of our knowledge, there is limited data regarding the pathogenesis, causative organisms, and management of this condition. Conclusion Emphysematous hepatitis is a rapidly progressive infection that can be fatal in the absence of appropriate therapeutic intervention. Initial clinical manifestations are usually subtle and thus high clinical suspicion is required for early diagnosis and management of this condition to help decrease the mortality rates.
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Affiliation(s)
- Ryosuke Echigoya
- Department of Emergency Medicine, Kurashiki Central Hospital, Japan
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Kim JH, Jung ES, Jeong SH, Kim JS, Ku YS, Hahm KB, Kim JH, Kim YS. A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma. THE KOREAN JOURNAL OF HEPATOLOGY 2012; 18:94-7. [PMID: 22511909 PMCID: PMC3326990 DOI: 10.3350/kjhep.2012.18.1.94] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 08/04/2011] [Accepted: 09/02/2011] [Indexed: 12/14/2022]
Abstract
An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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Kaushik S, Gossage JR. A 31-Year-Old Man With Liver Transplant and Progressive Jaundice. Chest 2010; 138:448-51. [DOI: 10.1378/chest.09-2646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Létourneau-Guillon L, Audet P, Plasse M, Lepanto L. Answer to case of the month #162. Emphysematous infection of the liver parenchyma. Can Assoc Radiol J 2010; 61:117-9. [PMID: 20303023 DOI: 10.1016/j.carj.2009.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/03/2009] [Accepted: 10/05/2009] [Indexed: 02/08/2023] Open
Affiliation(s)
- Laurent Létourneau-Guillon
- Department of Radiology, University of Montreal, Saint-Luc Hospital, Saint-Denis, Montréal, Québec, Canada.
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Diaz GC, Boyer T, Renz JF. Survival of Clostridium perfringens sepsis in a liver transplant recipient. Liver Transpl 2009; 15:1469-72. [PMID: 19877220 DOI: 10.1002/lt.21855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Clostridium perfringens sepsis following orthotopic liver transplantation (OLT) is a rare but reported complication that historically results in mortality or emergent retransplantation (ReTx). Complications from C. perfringens emphysematous gastritis have contributed to the death of a healthy live liver donor as well. Herein, we describe the first documented survivor of C. perfringens sepsis following OLT managed without laparotomy or emergent ReTx.
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Affiliation(s)
- Geraldine C Diaz
- Department of Anesthesiology, University of Arizona, Tucson, AZ, USA
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Affiliation(s)
- James D Perkins
- Liver Transplantation Worldwide, University of Washington Medical Center, Seattle, WA, USA
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