1
|
Saeki Y, Moriyama Y, Araki Y, Oda A, Nakaoka K, Inagaki M. Gas Gangrene after Thoracic Drainage for Empyema with Tension Pneumothorax. Am J Respir Crit Care Med 2023; 208:814-815. [PMID: 37339519 DOI: 10.1164/rccm.202207-1322im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/20/2023] [Indexed: 06/22/2023] Open
Affiliation(s)
- Yusuke Saeki
- Department of Thoracic Surgery
- Department of Thoracic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Yuichi Araki
- Department of Emergency Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan, and
| | | | | | | |
Collapse
|
2
|
Mahjoubi MF, Rezgui B, Essid N, Karoui Y, Charradi H, Kandara H, Ben Moussa M, Maatouk M. A dark threat to a developing country: gas gangrene of the lower limb is still proving its existence. Eur J Orthop Surg Traumatol 2023; 33:3207-3211. [PMID: 37043056 DOI: 10.1007/s00590-023-03536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Mohamed Farès Mahjoubi
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia.
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Bochra Rezgui
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Nada Essid
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Yasser Karoui
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Heni Charradi
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hajer Kandara
- Department of Endocrinology A, National Institute of Nutrition, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mounir Ben Moussa
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mohamed Maatouk
- Department of Surgery A, Charles Nicolle Hospital, 1007, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
3
|
McCarty AR, Villarreal ME, Tamer R, Strassels SA, Schubauer KM, Paredes AZ, Santry H, Wisler JR. Analyzing Outcomes Among Older Adults With Necrotizing Soft-Tissue Infections in the United States. J Surg Res 2020; 257:107-117. [PMID: 32818779 DOI: 10.1016/j.jss.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Necrotizing soft-tissue infections (NSTIs) encompass a group of severe, life-threatening diseases with high morbidity and mortality. Evidence suggests advanced age is associated with worse outcomes. To date, no large data sets exist describing outcomes in older individuals, and risk factor identification is lacking. METHODS Retrospective data were obtained from the 2015 Medicare 100% sample. Included in the analysis were those aged ≥65 y with a primary diagnosis of an NSTI (gas gangrene, necrotizing fasciitis, cutaneous gangrene, or Fournier's gangrene). Risk factors for in-hospital mortality and discharge disposition were examined. Continuous variables were assessed using central tendency, t-tests, and Wilcoxon rank-sum tests. Categorical variables were assessed using the chi-squared and Fisher's exact tests. Statistical significance was defined as P < 0.05. RESULTS 1427 patient records were reviewed. 59% of patients were male, and the overall mean age was 75.4±8.6 y. 1385 (97.0%) patients required emergency surgery for their NSTI diagnosis. The overall mortality was 5.3%. Several underlying comorbidities were associated with higher rates of mortality including cancer (OR: 3.50, P = 0.0009), liver disease (OR: 2.97, P = 0.03), and kidney disease (OR: 2.15, P = 0.01). While associated with high in-hospital mortality, these diagnoses were not associated with a difference in the rate of discharge to home compared with skilled nursing or rehab. Overall, patients discharged to skilled nursing facilities or rehab had higher rates of underlying comorbidities than patients who were discharged home (3 or more comorbid illness 84.3% versus 68.6%, P < 0.0001); however, no individual comorbid illness was associated with discharge location. CONCLUSIONS In our Medicare data set, we identified several medical comorbidities that are associated with increased rates of in-hospital mortality. Patients with underlying cancers had the highest odds of increased mortality. The effect on outcomes of the potentially immunosuppressive cancer treatments in these patients is unknown. These data suggest that patients with underlying illnesses, especially cancer, kidney disease, or liver disease have higher mortalities and are more likely to be discharged to skilled nursing facilities or rehab. It is unclear why these illnesses were associated with these worse outcomes while others including diabetes and heart disease were not. These data suggest that these particular comorbid illnesses may have special prognostic implications, although further analysis is necessary to identify the causative factors.
Collapse
Affiliation(s)
- Adara R McCarty
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio.
| | - Michael E Villarreal
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Robert Tamer
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Scott A Strassels
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio; Ohio State University, Wexner Medical Center Center For Surgical Health Assessment, Research And Policy (SHARP), Columbus, Ohio
| | - Kathryn M Schubauer
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Anghela Z Paredes
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Heena Santry
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio; Ohio State University, Wexner Medical Center Center For Surgical Health Assessment, Research And Policy (SHARP), Columbus, Ohio
| | - Jon R Wisler
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| |
Collapse
|
4
|
Palenčár D, Švec A. [Vascularised Fibula and Tendon Transfer in the Comprehensive Treatment of Forearm Fracture with Gas Gangrene Complication]. Acta Chir Orthop Traumatol Cech 2019; 86:290-293. [PMID: 31524592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.
Collapse
Affiliation(s)
- D Palenčár
- Klinika plastickej, rekonštrukčnej a estetickej chirurgie Lekárskej fakulty Univerzity Komenského v Bratislave a Univerzitnej nemocnice Bratislava
| | | |
Collapse
|
5
|
Savran MM, Thinggaard E, Nielsen-Breining M, Kirschner B. [Life-threatening intrauterine infection with Clostridium perfringens]. Ugeskr Laeger 2018; 180:V01180019. [PMID: 29984702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this case report, a 40-year-old woman with a history of a uterine leiomyoma presented with abdominal pain and fever. Initially, her symptoms were associated with a bleeding from an ovarian cyst seen on a CT scan of the abdomen showing free intraperitoneal fluid surrounding the internal genitals. Meanwhile, her blood cultures came out positive for Clostridium perfringens, and her condition deteriorated despite intravenous antibiotics. A new CT scan revealed intrauterine gas development. A laparotomy was performed with removal of the internal genitals, and the patient improved on continuous antibiotics.
Collapse
|
6
|
Brönnimann A, Piso RJ, Paganoni R, Studhalter M. [Not Available]. Praxis (Bern 1994) 2017; 106:837-840. [PMID: 28745116 DOI: 10.1024/1661-8157/a002744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Zusammenfassung: Wir berichten über einen 69-jährigen Patienten, bei dem eine mikrochirurgische Dekompression und Diskektomie durchgeführt wurde. Im Verlauf entwickelte er stärkste Beinschmerzen ohne Ansprechen auf eine Schmerztherapie. Die durchgeführte Computertomografie zeigte grosse Lufteinschlüsse im retroperitonealen Raum von subdiaphragmal bis ins kleine Becken. Trotz sofortiger und radikaler chirurgischer Sanierung sowie antibiotischer Therapie starb der Patient noch im Operationssaal. Die vielzähligen intraoperativen Biopsien sowie alle Blutkulturen waren postmortem positiv für Clostridium perfringens.
Collapse
Affiliation(s)
- Alain Brönnimann
- 1 Departement perioperative Medizin, Klinik für Intensivmedizin, Kantonsspital Olten
| | - Rein Jan Piso
- 2 Medizinische Klinik, Infektiologie, Kantonsspital Olten
| | - Reto Paganoni
- 1 Departement perioperative Medizin, Klinik für Intensivmedizin, Kantonsspital Olten
| | - Michael Studhalter
- 1 Departement perioperative Medizin, Klinik für Intensivmedizin, Kantonsspital Olten
| |
Collapse
|
7
|
Makarawo TP, Shea J, Smithson L. Necrotizing myonecrosis secondary to hematogenous spread of gas gangrene following colonic perforation. Int J Colorectal Dis 2016; 31:157-8. [PMID: 25787163 DOI: 10.1007/s00384-015-2185-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Tafadzwa P Makarawo
- Department of Surgery, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI, 48075, USA.
| | - John Shea
- Department of Surgery, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI, 48075, USA
| | - Lauren Smithson
- Department of Surgery, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI, 48075, USA
| |
Collapse
|
8
|
Wang Y, Lu B, Hao P, Yan MN, Dai KR. Comprehensive treatment for gas gangrene of the limbs in earthquakes. Chin Med J (Engl) 2013; 126:3833-3839. [PMID: 24157141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Mortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients. METHODS We retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China's Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene. RESULTS Of 226 patients with limbs open injuries sustained during the earthquake, 53 patients underwent smear analysis of wound exudates and gas gangrene was diagnosed in 19 patients. The average elapsed time from injury to arrival at the hospital was 72 hours, from injury to definitive diagnosis was 4.3 days, and from diagnosis to conversion of negative findings on wound smear analysis to positive findings was 12.7 days. Anaerobic cultures were also obtained before wound closure. The average elapsed time from completion of surgery to recovery of normal vital signs was 6.3 days. Of the 19 patients, 16 were treated with open amputation, two with closed amputation, and 1 with successful limb salvage; 18 patients were successfully treated and one died. CONCLUSIONS In earthquakes, rapid, accurate screening and isolation are essential to successful treatment of gas gangrene and helpful in preventing nosocomial diffusion. Early and thorough debridement, open amputation, and active supportive treatment can produce satisfactory therapeutic results.
Collapse
Affiliation(s)
- Yue Wang
- Department of Orthopaedics, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan 610000, China
| | | | | | | | | |
Collapse
|
9
|
Dralle H, John E. [Necrotizing soft tissue infections: the timing of therapy is decisive!]. Chirurg 2012; 83:941-2. [PMID: 23089946 DOI: 10.1007/s00104-012-2280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Dralle
- Universitätsklinik und -poliklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle, Halle (Saale), Deutschland.
| | | |
Collapse
|
10
|
|
11
|
|
12
|
Lazarescu C, Kimmoun A, Blatt A, Bastien C, Levy B. Clostridium perfringens gangrenous cystitis with septic shock and bone marrow necrosis. Intensive Care Med 2012. [PMID: 22797355 DOI: 10.1007/s00134-013-2647-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
13
|
Kawashima M, Hashimoto Y, Sudo T, Uemura K, Nakashima A, Sueda T, Murakami Y. A rare diagnostic challenge in acute appendicitis: a case report. Hiroshima J Med Sci 2012; 61:19-21. [PMID: 22702216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although rare, acute appendicitis presenting as a remote abscess with cellulitis in the gluteal region, retroperitoneal region, groin, or thigh does occur and may present a diagnostic challenge. We report a case of a 78-year-old woman presenting with an extensive gas-forming abscess in the right gluteal region secondary to perforated appendicitis without significant gastrointestinal symptoms. Computed tomography (CT) demonstrated a retroperitoneal abscess extending along the sacropelvic surface of the ilium to the subcutaneous tissue. Subsequently, laparotomy revealed retrocecal appendicitis perforated at the base of the cecum, and contained in the retroperitoneum without any signs of peritonitis. This case not only represents an unusual manifestation of acute appendicitis, but also alerts us to the importance of anatomical considerations when interpreting disease extent with imaging. In the differential diagnosis of gluteal or upper thigh abscesses, the rare possibility of perforated acute appendicitis should be considered.
Collapse
Affiliation(s)
- Masumi Kawashima
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University Hiroshima 734-8551, Japan
| | | | | | | | | | | | | |
Collapse
|
14
|
van der Veen GJ. [Wound healing: complications after dehorning]. Tijdschr Diergeneeskd 2011; 136:802-803. [PMID: 22164469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
15
|
Men'shikova ED, Titova GP, Kartavenko VI, Sokolov VA, Shabanov AK, Men'shikov DD. [Microbiological diagnosis of gas gangrene caused by Clostridium septicum (a clinical case)]. Klin Lab Diagn 2010:53-55. [PMID: 20886724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C. bifermentans that were identified as C. septicum on cultural diagnosis. The pathogenic C. septicum strain spores were likely to be formed in the macroorganism upon exposure of the pathogen to a patient's defense factors and to a package of therapeutic measures. Microbiological data should be used only in combination with clinical and instrumental findings and the results of other laboratory studies when the optimal technology is chosen to treat gas infection. By keeping in mind that there may be clostridial gangrene in the patients and the experience of clinicians and bacteriologists may be insufficient in diagnosing this pathology, it is necessary to strengthen the training of physicians in the diagnosis of this pathology.
Collapse
|
16
|
Pita Zapata E, Sarmiento Penide A, Bautista Guillén A, González Cabano M, Agulla Budiño JA, Camba Rodríguez MA. [Massive intravascular hemolysis secondary to sepsis due to Clostridium perfringens]. Rev Esp Anestesiol Reanim 2010; 57:314-316. [PMID: 20527348 DOI: 10.1016/s0034-9356(10)70234-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.
Collapse
Affiliation(s)
- E Pita Zapata
- Servicio de Anestesiología y Reanimación, Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, A Coruña.
| | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Ching-Wei Chang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
18
|
Abstract
Skin and soft tissue infections are common diseases. The spectrum ranges from slight furuncles to severe necrotizing soft tissue infections. Grampositive bacteria account for 70-80 % of cases as causative organisms. Diagnostics include rapid evaluation of locally limited or diffuse spreading extent of the disease. In complicated skin and soft tissue infections, surgical intervention with debridement and necronectomy is indicated. Necrotizing skin and soft tissue infections call for programmed redebridement. If systemic signs of inflammation are present (fever > 38 degrees C, leukocytosis, CRP elevation) or significant comorbidity exists, application of antibiotics is indicated. The prognosis in operatively treated patients is dependent on the time of surgical intervention.
Collapse
Affiliation(s)
- P Kujath
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Chirurgie, Lübeck, Germany.
| | | | | | | |
Collapse
|
19
|
Kobayashi S, Negoro K, Uchida K, Kokubo Y, Takeno K, Yayama T, Katayama K, Yamaguchi A, Baba H. Successful treatment of nonclostridial gas gangrene extending from retroperitoneum to thigh associated with occult cecal cancer. J Orthop Sci 2007; 12:585-91. [PMID: 18040642 DOI: 10.1007/s00776-007-1172-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 06/20/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Shigeru Kobayashi
- Department of Orthopaedics, Fukui University School of Medicine, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- D Nasr
- Service de chirurgie digestive, Hôpital des Chanaux - Mâcon, France.
| | | | | |
Collapse
|
21
|
Asciutto G, Geier B, Marpe B, Hummel T, Mumme A. A case of contained ruptured aortitis due to Clostridium septicum infection in a patient with a colon malignancy. Chir Ital 2007; 59:743-746. [PMID: 18019648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We discuss a case of contained ruptured aortitis due to Clostridium septicum infection in a 71-year-old man, who had undergone a right hemicolectomy and cholecystectomy to treat an ascending colon carcinoma. Computed tomography identified a juxtarenal abdominal aneurysm with gas formation in the right psoas muscle. Emergency abdominal exploration revealed a ruptured aortitis. After in situ graft replacement of the abdominal aorta, Clostridium septicum was identified in tissue culture. Antibiotic therapy with penicillin G was administered. The postoperative course was complicated by a retroperitoneal haematoma which necessitated surgical revision. The patient was discharged 2 months afterwards. At clinical monitoring at 6 months he is still doing well.
Collapse
Affiliation(s)
- Giuseppe Asciutto
- Klinik für Gefässchirurgie, St. Josef-Hospital, Klinikum der Ruhr-Universität, Bochum
| | | | | | | | | |
Collapse
|
22
|
Abstract
Clostridium perfringens is a rare, life-threatening infection. We present an atypical evolution of spontaneous Clostridium perfringens myonecrosis in a monitored healthy patient. After a head injury, the hemodynamically stable patient became febrile and grew cultures of Clostridium perfringens with no identifiable focus. Antibiotics were initiated. Seventy-two hours after culture results, the patient complained of shoulder pain and imaging revealed periscapular subcutaneous emphysema. Multiple surgical débridements of the necrotic supraspinatus muscle were required to eradicate the infection. The unique features of this patient include the opportunity to (1) follow the progression of clostridial myonecrosis in a healthy patient in a monitored setting and (2) study the extended period of time between positive cultures and the onset of clinical myonecrosis, a feature at odds with the classic rapid progression.
Collapse
Affiliation(s)
- Brent Lanting
- Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | | | | |
Collapse
|
23
|
|
24
|
|
25
|
Jackisch T, Freitag M, Ludwig K. [Gas gangrene with ulcerative colitis under immunosuppressive therapy: report of a case]. Zentralbl Chir 2006; 131:84-7. [PMID: 16485217 DOI: 10.1055/s-2006-921399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report on a 30-year-old male with ulcerative colitis who developed a spontaneous gas gangrene in the right limb, the gluteal muscles and the retroperitoneal region under immunosuppressive therapy. In spite of immediate aggressive surgical and antibiotic therapy the massive infection led to septicemia and ultimately death. Clostridium septicum was identified with multiple local manifestations in the skeletal muscles. Gas gangrene is extremely rare in patients with ulcerative colitis or Crohn's disease and immunosuppression. The therapeutic options are discussed and the relevant present literature is reviewed.
Collapse
Affiliation(s)
- T Jackisch
- Klinik für Allgemein- und Abdominalchirurgie, Krankenhaus Dresden-Friedrichstadt, Akademisches Lehrkrankenhaus der TU Dresden, Friedrichstrasse 41, 02067 Dresden.
| | | | | |
Collapse
|
26
|
Affiliation(s)
- Juan F Alvarez-García
- Servicio de Medicina Interna, Hospital San Pedro de Alcántara, Complejo Hospitalario de Cáceres, Cáceres, Spain
| | | | | | | |
Collapse
|
27
|
Affiliation(s)
- Richard W Titball
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| |
Collapse
|
28
|
El-Masry S. Spontaneous gas gangrene associated with occult carcinoma of the colon: a case report and review of literature. Int Surg 2005; 90:245-7. [PMID: 16548324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Clostridium septicum infection is a rare cause of spontaneous nontraumatic gas gangrene. The resultant myonecrosis is acutely painful and rapidly fatal. The infection occurs in the absence of trauma and is usually associated with an underlying malignancy. A case of spontaneous gas gangrene of the upper limb caused by C. septicum infection associated by carcinoma of the colon is presented, with a review of the literature.
Collapse
Affiliation(s)
- Sherif El-Masry
- Department of Surgery, Insurance Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
29
|
Abstract
Atraumatic infections due to Clostridium septicum are known to be associated with immunosuppression or even malignancy. In this case report, we present a patient with severe Clostridium septicum infection related to advanced colon cancer that had not previously been diagnosed. The case demonstrates the strong association between Clostridium septicum infections and malignancy, particularly in the presence of other predisposing diseases such as diabetes mellitus. It strongly suggests excluding malignant neoplasms, especially of the gastrointestinal tract, when severe Clostridium septicum infections occur. Moreover, if patients with known colorectal or other malignancy develop septicaemia or spontaneous gas gangrene, clinicians should be aware of Clostridium septicum as one of the main causative agents, as early diagnosis and aggressive treatment are important to improve prognosis.
Collapse
Affiliation(s)
- A Mischke
- Institut für Medizinische Mikrobiologie, Universitätsklinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE To report 2 cases of severe gas gangrene secondary to Clostridium perfringens in pediatric oncology patients. METHODS We describe 2 children with acute presentations of gas gangrene secondary to C. perfringens. Both children were initially seen and treated in a community hospital emergency department and subsequently were cared for in a pediatric intensive care unit in a tertiary care, university-based children's hospital. RESULTS Both children demonstrated severe and unrelenting decompensation and required operative intervention within the first hospital day, which included amputation of the infected limb. One child survived and one child expired despite heroic measures. CONCLUSIONS Gas gangrene secondary to C. perfringens is an uncommon but life-threatening and limb-threatening condition in pediatric cancer patients. A high index of suspicion in a immunocompromised child with cancer who presents with extremity pain in combination with neutropenia is the key to early diagnosis and may lead to improved survival. This disease requires prompt recognition and aggressive treatment to allow any hope of recovery. Emergency medicine physicians who treat these children should be aware of this severe and potentially fatal infectious process and should not delay treatment or prompt orthopedic surgery consultation.
Collapse
Affiliation(s)
- Ana-Maria M Temple
- Department of Pediatrics, Penn State Children's Hospital, Hershey, PA 17033, USA
| | | |
Collapse
|
31
|
Abstract
Spontaneous gas gangrene of the pancreas, caused by an infection of Clostridium perfringens, is an extremely rare but severe form of acute pancreatitis. A 67-year-old man complaining of severe epigastric pain with diffuse guarding underwent an emergency laparotomy. During surgery, hemorrhagic pancreatic necrosis was observed with a large amount of peripancreatic gas. Cultures demonstrated C. perfringens. The identification of hemolysis and the accumulation of peripancreatic gas on computed tomography, which were both caused by an infection of C. perfringens, led us to make a diagnosis of clostridial infection of the pancreas.
Collapse
Affiliation(s)
- Toru Ikegami
- Department of Surgery, Hiroshima Red Cross and Atomic Bomb Survivors Hospital, Hiroshima 730-8619, Japan
| | | | | | | |
Collapse
|
32
|
Assadian O, Assadian A, Senekowitsch C, Makristathis A, Hagmüller G. Gas gangrene due toClostridium perfringens in two injecting drug users in Vienna, Austria. Wien Klin Wochenschr 2004; 116:264-7. [PMID: 15143867 DOI: 10.1007/bf03041058] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe two cases of severe myonecrotic infections caused by Clostridium perfringens in injecting drug users (IDUs) in Vienna, Austria. Clostridial myonecrosis, or gas gangrene, is a clostridial infection primarily of muscle tissue. C. perfringens is isolated in 90% of these infections. Other clostridial species isolated are C. novyi, C. septicum, C. histolyticum, C. fallax, and C. bifermentans. Classically, clostridial myonecrosis has an acute presentation and a fulminant clinical course. It is diagnosed mainly on a clinical basis. The infection may be so rapidly progressive that any delay in recognition or treatment may be fatal. The onset is sudden, often within 4 to 6 hours after an injury. An early clinical finding is sudden severe pain in the area of infection. Swelling and edema in the area of infection is pronounced. At surgery, the infected muscle is dark-red to black, is noncontractile, and does not bleed when cut. Crepitus, although not prominent, is sometimes detected. We were able to demonstrate spores that were morphologically indistinguishable from spores of C. perfringens in a drug sample obtained from case 2. General practitioners and accident and emergency staff should be aware of the possibility of C. perfringens infection in IDUs, especially if injection into soft tissue is suspected.
Collapse
Affiliation(s)
- Ojan Assadian
- Department of General and Vascular Surgery, Wilhelminenspital, Vienna, Austria.
| | | | | | | | | |
Collapse
|
33
|
Lorea P, Baeten Y, Chahidi N, Franck D, Moermans JP. A severe complication of muscle transfer: clostridial myonecrosis. ANN CHIR PLAST ESTH 2004; 49:32-5; discussion 36. [PMID: 15013531 DOI: 10.1016/j.anplas.2003.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Accepted: 12/03/2003] [Indexed: 10/26/2022]
Abstract
We present a case of gas gangrene as a severe complication of muscle transfer for opponensplasty. After debridement, the extensive palmar wound was covered by a free gracilis muscle transfer. This complication of muscle transfer has to our knowledge never been reported previously.
Collapse
Affiliation(s)
- Patrick Lorea
- SOS Main Strasbourg, Clinique des Diaconesses, 4, rue Ste Elisabeth, 67000 Strasbourg, France.
| | | | | | | | | |
Collapse
|
34
|
Abstract
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.
Collapse
Affiliation(s)
- R W Goyal
- Department of Orthopaedics, Royal Preston Hospital, Preston, UK.
| | | | | |
Collapse
|
35
|
Buczyński K, Goździuk K, Wilczyński G, Furmanik F. [A rare case of gaseous gangrenous mediastinitis]. Pneumonol Alergol Pol 2003; 71:95-8. [PMID: 12959029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
We report a case of a cervical phlegmone and mediastinitis descending from peridental abscess in 32-year old student. Emergency left thoracotomy was performed after CT evaluation in which multiple fluid levels and gas spaces were found. After 72 hours bacterial strains showed Clostridium perfringens in fluid taken from left pleural cavity and patient was sent to Hiberbaric Center in Gdynia, where he underwent hyperbaric oxygen therapy. After 10 days the patient was brought back in good condition to our Department. After 3 days he died because of sudden massive bleeding caused by necrosis of aorta wall.
Collapse
|
36
|
Abstract
Clostridium septicum gas gangrene is a rare fulminant infectious disease for which signs and symptoms like extreme pain, subcutaneous crepitus and violaceous necrotic bullae must be recognised. Early diagnosis followed by large surgical debridement are the only ways to ameliorate the bad prognosis. Here we describe a case of cervico-thoracic spontaneous gas gangrene.
Collapse
Affiliation(s)
- P Carron
- Division des soins intensifs, hôpital Riviera, site du Samaritain, boulevard Paderewsky 3, 1800 Vevey, Suisse
| | | |
Collapse
|
37
|
Chan G, Tchervenkov J, Cantarovich M, Alpert E, Deschenes M, Ergina P, Metrakos P, Barkun J. Veno-atrial bypass for the operative treatment of septic gas gangrene secondary to delayed hepatic artery thrombosis. Am J Transplant 2003; 3:760-3. [PMID: 12780569 DOI: 10.1034/j.1600-6143.2003.00129.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The occurrence of late hepatic artery thrombosis after orthotopic liver transplantation can result in gas gangrene of the graft. This clinical scenario has the potential to be rapidly fatal as a result of fulminant hepatic failure, sepsis and multiple-organ-failure syndrome. Emergency operative intervention is indicated to remove the septic source and replace the failed liver. In this report, both cases demonstrated rapid deterioration within 24 h from the onset of symptoms, in spite of maximum supportive care. Intra-operative handling of the gangrenous graft resulted in hemodynamic instability and a technically unfeasible hepatectomy. The use of extra-corporeal veno-atrial bypass, by isolating the septic source, allowed for graft hepatectomy and successful re-transplantation in the second of these reported cases.
Collapse
Affiliation(s)
- Gabriel Chan
- Department of Surgery, McGill Universiry Health Centre, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Jacob ZC, Dedekian M, Seoudi H. Nontraumatic clostridial myonecrosis: an indication for colonoscopy? Am Surg 2002; 68:463-5. [PMID: 12013291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Clostridial myonecrosis (CM) is a rare infection that usually arises after traumatic injury. Spontaneous or nontraumatic CM is even more rare and has been described in association with colorectal malignancy. These infections carry a high mortality rate and require urgent surgical intervention and intensive antibiotic therapy. This report describes a patient who presented with nontraumatic CM of the lower extremity in association with adenocarcinoma of the cecum.
Collapse
Affiliation(s)
- Zvi Charles Jacob
- Department of Surgery, Berkshire Medical Center, Pittsfield, Massachusetts, USA
| | | | | |
Collapse
|
39
|
Abstract
The progression of Clostridium perfringens endomyometritis to gas gangrene is a rare, but greatly feared complication in the obstetrical patient. While endometritis following cesarean delivery is a common complication, recognition of C. perfringens as the pathogen as well as its progression to gas formation in the myometrium is essential to the survival of the patient. We present a patient that we recently cared for, and review the bacteriology, clinical diagnosis, and management.
Collapse
Affiliation(s)
- Thomas F Halpin
- Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | | |
Collapse
|
40
|
Rouquette-Vincenti I, Petitjeans F, Villevieille T, Szymczyszyn P, Fangio P, Baranger B, Brinquin L. [Obesity, diabetes mellitus, and gas gangrene: a major therapeutic challenge]. Ann Endocrinol (Paris) 2001; 62:525-8. [PMID: 11845028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Soft tissue infections are uncommon but prognosis is severe (20 to 50%). Management consists in surgical debridement, antibiotic therapy against anaerobic and aerobic bacteria, and appropriate intensive care. When available, hyperbaric oxygen therapy is an integral part of the treatment. We report the case of 56-year-old female patient with diabetes (150 kg) was hospitalized in our unit a few days after surgical treatment of a buttocks abscess for clinical signs of peripheral gas gangrene. Surgical exploration showed necrotizing soft tissue infection with fasciitis. Adequate therapy using antibiotics, surgery daily and hyperbaric oxygen was given. Therapy had to be adapted to the patient's obesity. Outcome was good with recovery and few sequelae, allowing transfer to a medical ward.
Collapse
|
41
|
Affiliation(s)
- B J Al Bahrani
- Medical Oncology Department, Cancer Therapy Centre, Liverpool Hospital, NSW
| | | | | |
Collapse
|
42
|
Abstract
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.
Collapse
Affiliation(s)
- R K Rai
- Monklands District General Hospital, Airdrie, Scotland
| | | | | | | | | |
Collapse
|
43
|
Salo JA, Savola JK, Toikkanen VJ, Perhoniemi VJ, Pettilä VY, Klossner JA, Toivonen HJ. Successful treatment of mediastinal gas gangrene due to esophageal perforation. Ann Thorac Surg 2000; 70:2143-5. [PMID: 11156138 DOI: 10.1016/s0003-4975(00)02019-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Esophageal perforation and mediastinal gas gangrene developed in a 55-year-old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. Initially, extensive gangrene of the esophagus and the mediastinum was treated by esophagectomy; however, an abundance of Clostridium perfringens in the Gram stain verified the presence of gas gangrene. Subsequently, the patient was transferred to a hyperbaric oxygen center, wherein a total of seven hyperbaric treatments were administered. The patient survived, and 4 months later, after having undergone several reoperations because of pleural empyema, mediastinal abscess, splenic rupture, and acalculous cholecystitis, was discharged and is still surviving.
Collapse
Affiliation(s)
- J A Salo
- Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
| | | | | | | | | | | | | |
Collapse
|
44
|
Mathonnet M, Maisonnette F, Gainant A, Cubertafond P. [Rectal adenocarcinoma revealed by perineal gas gangrene]. Ann Chir 2000; 53:925-7. [PMID: 10633946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M Mathonnet
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU Dupuytren, Limoges
| | | | | | | |
Collapse
|
45
|
Abstract
The haemophilia patient tends to live a more protected life than his normal counterpart, this is particularly so in underdeveloped and developing countries where due to poor health infrastructure, financial constraints and nonavailability of factor concentrates, patients quickly learn that they need to live a protected life. Under such circumstances, gas gangrene seems to be a very unusual infection for this group of patients. We report here a 25-year-old male with severe haemophilia who developed gas gangrene due to inadequate medical management following a road traffic accident. Subsequently, his affected limb was salvaged by conservative therapy. A literature search failed to reveal any reports of similar patients in the English literature.
Collapse
Affiliation(s)
- K Ghosh
- Comprehensive Haemophilia Care Centre at Institute of Immunohaematology and Haematology Unit of KEM Hospital, Mumbai - 400012, India
| | | | | | | |
Collapse
|
46
|
Abstract
A 24-year-old healthy man developed Clostridium perfringens myonecrosis with severe sepsis after plating of a closed femoral fracture. The leg could be preserved by complete resection of the fascia from all muscle compartments of the leg, including the pelvitrochanteric and the iliopsoas muscles, radical removal of necrotic muscle tissue, dissection of the para-aortal infrarenal lymphatics, daily débridements over 2 weeks, and systemic antibiotic therapy. The plate was removed because of a second septic episode followed by temporary stabilization with external fixation. After soft-tissue healing, plate fixation was carried out. The patient developed significant deficit of knee flexion (0 degree/0/20 degrees) due to heterotopic ossification of the quadriceps femoris muscle that could be improved by partial resection of heterotopic bone formation. In the same operation the bony defect of the femur was filled with autologous bone graft. The fracture healed 10 months after the accident. The patient can work full time in his previous profession as a mechanic, but again needs operative mobilization of the knee joint, including open arthrolysis and quadriceps plasty.
Collapse
Affiliation(s)
- M Keel
- Klinik für Unfallchirurgie, Universitätsspital Zürich
| | | | | |
Collapse
|
47
|
Bogdanov SV, Levashov VA, Vedrintseva VV, Brezhnev IV. [The successful treatment of an anaerobic gas infection of the lower extremity at a district hospital]. Vestn Khir Im I I Grek 1999; 158:68-9. [PMID: 10368899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
48
|
Kraljevic D, Druzijanic N, Tomic I, Juricic J, Petri N. Hyperbaric oxygenation as adjuvant therapy to surgery of emphysematous cholecystitis. Hepatogastroenterology 1999; 46:775-7. [PMID: 10370610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Three cases of emphysematous cholecystitis are presented. The role of hyperbaric oxygenation as excellent adjuvant therapy to urgent surgical as well as intensive conservative treatment is emphasized.
Collapse
Affiliation(s)
- D Kraljevic
- Department of Abdominal Surgery, Clinical Hospital Split, Croatia
| | | | | | | | | |
Collapse
|
49
|
Winter E, Dommke A, Bongers-Binder S, Eiring P, Weise K. Exogenously acquired Clostridium septicum gas gangrene--a case report. Swiss Surg 1999:316-8. [PMID: 9887679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We report on a 72-year-old woman suffering from gas gangrene of the right leg, which developed 3 days after getting injured while gardening. Due to rapid microbiological diagnosis-direct microscopical examination of muscle biopsies revealed numerous grampositive rods-, immediately performed amputation of the leg and antibiotic treatment with penicillin and metronidazole the patient survived. From the muscle biopsies Clostridium septicum, which is found ubiquitously, was isolated in pure culture.
Collapse
Affiliation(s)
- E Winter
- Berufsgenossenschaftliche Unfallklinik Tuebingen, Department of Trauma Surgery, University of Tübingen
| | | | | | | | | |
Collapse
|
50
|
Abstract
Gas gangrene is not a frequently encountered toxic wound infection in childhood. We present a case of postoperative Clostridium perfringens infection with proximal forearm myonecrosis. In order to reveal the full extent of tissue viability in the right upper extremity, infrared thermography was performed. Although dyschromia was evident in the proximal forearm, thermographs revealed viable tissue only up to the supracondylar region. Angiography, which provided valuable clues to the patency of the vascular supply, and subsequent intraoperative findings confirmed the extent of tissue perfusion as revealed by infrared thermography.
Collapse
Affiliation(s)
- A K Saxena
- Department of Pediatric Surgery, University of Münster, Germany
| | | | | | | | | |
Collapse
|