A rare cause of pneumoperitoneum due to clostridium perfringens in a cirrhotic patient

Abstract

Introduction

Abdominal gas gangrene caused by Clostridium perfringens is a rare differential diagnosis to pneumoperitoneum caused by bowel perforation. There are only a handful of case reports on this topic.

Patients and methods

We present the case of a 58 year old cirrhotic patient who represented to our ER after complicated surgery for retroperitoneal liposarcoma. On admission he complained of abdominal pain and mild fever. Due to leukocytosis and CRP a CT scan was performed which showed extensive free air. The patient was taken to the OR for suspected bowel perforation. No perforation could be identified after extensive search and lavage.

Results

Twelve hours after surgery microbiology reported extensive growth of clostridium perfringens in the cultures drawn from ascites. The patient was successfully treated with antibiotics and discharged home soon after.

Conclusion

Gas gangrene is a rare differential diagnosis to bowel perforation. Most reported cases are from cirrhotic patients. If no perforation can be identified in the OR postoperative antibiotics should cover clostridium perfringens.

Keywords:

• Clostridium perfringens
• gas gangrene
• cirrhosis
• pneumoperitoneum
• peritonitis

Ethical approval

The studied subject has given written consent for the publication of his case. Ethical approval was not required due to the retrospective observational nature of this case report.

Author contributions

Jens Strohäker has written the manuscript and done most of the literature research. Alfred Königsrainer has given feedback regarding structuring of the case report and literature. Christian Beltzer has obtained consent by the patient and done both the surgical procedure as well as the patient follow-up care. He has also conceptualized this study.

Disclosure statement

The authors have no conflicts of interest to declare.