ABSTRACT
Clostridial gas gangrene of the abdominal wall is rare, and it is usually associated with organ perforation, immunosuppression or gastrointestinal malignancies. In this paper, we present a case of fulminant, endogenous gas gangrene in a 58-year old diabetic female with arterial hypertension and atherosclerosis, following uneventful laparoscopic cholecystectomy. She developed gas gangrene of the abdominal wall 12-hours after cholecystectomy and died 24-hours after the onset of the first symptoms, in spite oftreatment.
La gangrena gaseosa clostridial de la pared abdominal es rara, y normalmente se halla asociada con la perforación de órganos, inmunosupresión o malignidades gastrointestinales. En este trabajo, se presenta un caso de gangrena gaseosa endógena fulminante en una mujer diabética de 58 años con hipertensión arterial y ateroesclerosis, tras una colecistectomía laparoscópica sin incidentes. Doce horas después de la colecistectomía, la mujer desarrolló una gangrena gaseosa de la pared abdominal, y murió 24 horas después del comienzo de los primeros síntomas, a pesar del tratamiento.
Subject(s)
Female , Humans , Middle Aged , Abdominal Wall/microbiology , Cholecystectomy, Laparoscopic/adverse effects , Clostridium Infections/diagnosis , Gas Gangrene/microbiology , Atherosclerosis/complications , Fatal Outcome , Hypertension/complicationsABSTRACT
Schistosomiasis is an infection of trematodes, Schistosoma, causing periportal fibrosis and liver cirrhosis due to deposition of eggs in the small portal venules. In schistosomiasis caused by S. mansoni, sonography shows echogenic thickening or fibrotic band along the portal veins. CT shows low-attenuation bands or rings around the large portal vein branches in the central part of the liver with marked enhancement. Hepatoplenomegaly, liver cirrhosis, portal hypertension and gastroesophageal varies are commonly associated. In schistosomiasis caused by S. japonicum, sonography shows echogenic septae in the liver, utlining the polygonal liver lobules, mimicking "fish-scale" network appearance, reflecting fibrosis. CT shows periportal septae in the peripheral part of the liver parenchyma, producing "turtle-back" appearance, representing calcified eggs along the portal tracts. The portal tracts and hepatic capsule are enhanced on contrast-enhanced CT images. The size and shape of the liver are relatively preserved. MR images show fibrous septae as low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and these fibrous septae are enhanced. CT images of the lungs show multiple scattered nodules with halo of ground-glass opacities. Exudative granulomatous inflammation of the colonic wall may produce inflammatory polyps, fibrous thickening or stenosis of the colonic wall.