title: Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor.
abstract: A 57-year-old male with a history of hypercholesterolemia and anxiety but otherwise in good health volunteered to donate the right lobe of his liver to his brother. The operation was performed uneventfully, without transfusion. Postoperatively he did well, until he developed tachycardia, profound hypotension, and coffee ground emesis on postoperative day 3. Despite resuscitative measures, he arrested and expired. Autopsy demonstrated gas gangrene of the stomach as the underlying cause of the hemorrhage and numerous colonies of Gram-positive bacilli were identified. Subsequent polymerase chain reaction (PCR) analysis identified these bacteria to be Clostridium perfringens (C. perfringens) type D. This patient's death was devastating, both to his family and his medical team. The impact of his death has transcended that of an individual occurrence. In conclusion, herein we present the facts and discuss this extraordinary example of florid clostridial infection and toxin-mediated shock. It was completely unexpected and probably unpreventable, and its cause was almost inconceivable.
authors.affiliation: Recanati / Miller Transplantation Institute, New York, NY, USA. drlivers@aol.com
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Leona
authors.initials: L
authors.lastname: Kim-Schluger
authors.forename: Patrick
authors.initials: P
authors.lastname: Lento
authors.forename: Julia
authors.initials: J
authors.lastname: De La Garza
authors.forename: Josephine
authors.initials: J
authors.lastname: Wu
authors.forename: Boxun
authors.initials: B
authors.lastname: Xie
authors.forename: Wandi
authors.initials: W
authors.lastname: Zhang
authors.forename: Edward
authors.initials: E
authors.lastname: Bottone
authors.forename: David
authors.initials: D
authors.lastname: Zhang
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
mesh_terms: D003016:Clostridium perfringens / Q000302:isolation & purification*; D017809:Fatal Outcome; D005738:Gas Gangrene / Q000150:complications / Q000209:etiology* / Q000382:microbiology; D005756:Gastritis / Q000209:etiology; D006396:Hematemesis / Q000209:etiology*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D013272:Stomach Diseases / Q000150:complications / Q000209:etiology* / Q000382:microbiology; D009927:Tissue and Organ Procurement