Spontaneous intrahepatic gas gangrene and fatal septic shock.

Gas gangrene of the liver is a rare clinical syndrome associated with a high rate of mortality. It is mostly associated with malignancy and immunosuppression. We report on a male patient who presented at the department of emergency medicine with high fever but no localised complaints. CT scan revealed a cavitary lesion filled with air in the liver. Clostridium perfringens was proved to be present in the hepatic lesion and the blood, and clostridium perfringens sepsis with gas gangrene of the liver was diagnosed. Despite early diagnosis and treatment the patient died. The importance of "an aggressive treatment policy" in this kind of life-threatening disease is emphasised.

Early Belgian experience with the Kugel patch inguinal hernia repair.

The Kugel hernia repair is an open but minimally invasive, tension free repair, offering the advantages of a preperitoneal repair without the need for general anaesthesia. We report our initial experience with this technique in 25 inguinal hernia repairs. Operating time averaged 40 +/- 16 min, and one complication, a bladder tear, occurred intra-operatively. Patients were discharged after a median of 2 days and were then seen after 3 weeks and after at least one year. Three weeks postoperatively, there were two superficial skin inflammations and one haematoma. One year post-operatively no recurrences occurred but two patients complained of persistent inguinodynia. The Kugel hernia repair is a relatively new technique with a short operating time and minimal postoperative pain, but a learning curve, comparable to that of TEP has to be overcome in order to reproduce the results of its inventor.