[Gas gangrene of the abdominal wall due to underlying GI pathology: seven cases].
OBJECTIVE
Gas gangrene of the abdominal wall is a rare clinical occurrence with high rates of morbidity and mortality. The primary source of the infection is often unknown. To analyze the primary underlying intestinal etiologies and diagnostic approaches of gas gangrene of the abdominal wall, and to highlight specific treatment problems, particularly that of constructing a colostomy exteriorized through a massively infected abdominal wall.


METHODS
Seven cases of abdominal wall gas gangrene due to a gastrointestinal etiology were identified. (Cases arising from proctologic sources or related to recent abdominal surgery were excluded.) During the same period, 39 other patients presenting with abdominal wall gangrene from non-intestinal sources were treated.


RESULTS
The etiologies were: perforated sigmoid diverticulitis (n=2), perforated appendicitis (n=1), acute pancreatitis with associated cecal perforation (n=1), and perforated colorectal cancer (n=3). Four of the seven patients died despite treatment (mortality of 57%).


CONCLUSIONS
The clinical presentations of these seven cases demonstrate that a GI source must be suspected whenever a patient presents with abdominal wall gas gangrene, even when there are no specific GI symptoms. Imaging, particularly with CT scan, is essential both to visualize the extent of tissue necrosis and to reveal underlying primary GI pathology. This optimizes the surgical approach both by allowing for complete debridement and drainage of infected tissue, and by focussing the intervention on correction of the underlying primary GI source of infection.
Monneuse
O
O
Service d'Urgences Chirurgicales Viscérales, Hôpital Edouard Herriot - Lyon.
Gruner
L
L
Barth
X
X
Malick
P
P
Timsit
M
M
Gignoux
B
B
Tissot
E
E
D034861:Abdominal Wall; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001064:Appendicitis / Q000150:complications; D001424:Bacterial Infections / Q000188:drug therapy; D002429:Cecal Diseases / Q000150:complications; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000150:complications; D003125:Colostomy; D003646:Debridement; D004239:Diverticulitis, Colonic / Q000150:complications; D004322:Drainage; D005738:Gas Gangrene / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D012307:Risk Factors; D012810:Sigmoid Diseases / Q000150:complications; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents