Li HY, Wang ZX, Wang JC, Zhang XD. Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature. World J Clin Cases 2023; 11(4): 852-858 [PMID: 36818624 DOI: 10.12998/wjcc.v11.i4.852]
Corresponding Author of This Article
Xiao-Di Zhang, BSc, Chief Physician, Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, No. 52 Weiyang West Road, Qindu District, Xianyang 712000, Shaanxi Province, China. zhangxd215@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
He-Yun Li, Department of Intensive Care Unit, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
Zhi-Xiang Wang, Xiao-Di Zhang, Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
Jian-Chun Wang, Department of Healthcare-associate Infection Management, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
Author contributions: Zhang XD and Li HY were responsible for patient treatment and case analysis; Wang ZX and Wang JC were responsible for consulting the literature and writing articles.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Di Zhang, BSc, Chief Physician, Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, No. 52 Weiyang West Road, Qindu District, Xianyang 712000, Shaanxi Province, China. zhangxd215@163.com
Received: August 12, 2022 Peer-review started: August 12, 2022 First decision: October 21, 2022 Revised: November 28, 2022 Accepted: January 9, 2023 Article in press: January 9, 2023 Published online: February 6, 2023 Processing time: 177 Days and 23.2 Hours
Abstract
BACKGROUND
Abdominal Clostridium perfringens (C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C. perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.
CASE SUMMARY
A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation, we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained. Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to Guillain-Barre syndrome 75 d after the first surgery. This paper presents this case of intra-abdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.
CONCLUSION
When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage, appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.
Core Tip: Intra-abdominal gas gangrene caused by closed abdominal injury is extremely rare. When using laparotomy and vacuum sealed drainage combined with intensive care and antibiotic treatment, patients passed the perioperative period smoothly. The diagnosis and treatment of this case is of guiding clinical significance.
