[Gas gangrene due to Clostridium septicum in a patient with an occult colonic neoplasm. A case report and review of the literature].
A case of gaseous gangrene by Clostridium septicum associated with colorectal cancer is presented. The patient evolved rapidly towards septic shock and death. Autopsy showed occult neoplasm and pelvic and retroperitoneal myonecrosis. An exceptional finding was that of myocarditis in which thick gram-positive bacilli were identified. A review of the literature was carried out regarding the pathogenesis and clinical manifestations of this disease. The association of colonic neoplasm and Clostridium septicum may be related with the sensitivity of the cells of this neoplasm to the toxins of the microorganisms. The usefulness of this cytotoxicity is being tested in the therapeutic reduction of tumoral mass. With respect to clinical attitude, all the authors agree on the need for clinical suspicion as to the possible existence of occult colon neoplasm in individuals with septic shock by gaseous gangrene with no obvious entry site. Diagnosis is performed by imaging techniques with barium enema and if this is normal colonoscopy is carried out. Emergency treatment consists in laparotomy with resection of the neoplasm and debridement of the area accompanied by hyperbaric oxygen and antibiotics.
Sáez Castillo
A I
AI
Servicio de Anatomía Patológica, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo.
Rodríguez Merlo
R
R
Brea Zubigaray
S
S
García García
J F
JF
Céspedes Mas
M M
MM
Mollejo Villanueva
M
M
D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary*; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000556:secondary*; D017809:Fatal Outcome; D005738:Gas Gangrene / Q000473:pathology*; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000473:pathology; D009336:Necrosis; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D012007:Rectum / Q000473:pathology; D012772:Shock, Septic / Q000473:pathology
Gangrena gaseosa por Clostridium septicum en un paciente con neoplasia de colon oculta. Presentación de un caso y revisión de la literatura.