title: Clostridium septicum sepsis and its implications.
abstract: An elderly gentleman, who had 12 years earlier been successfully treated for colon cancer, presented with fever, rigours, right upper quadrant abdominal pain and tenderness. A CT of the abdomen revealed a colonic mass distal to the hepatic flexure with multiple gas locules and a walled off perforation. He underwent a right hemicolectomy. Histology confirmed multifocal colonic adenocarcinoma. His admission blood cultures grew Clostridium septicum. A week postoperatively he developed intermittent fevers and abdominal pain. Repeat CT revealed an abdominal collection adjacent to the new anastomosis, but more importantly, a sharply shouldered aneurysmal dilation of the infra-renal abdominal aorta. These findings prompted immediate surgical drainage of the collection, repair of the anastomostic leak, resection of the infected aortic aneurysm and replacement with a tube graft. This case highlights the clinical significance of C septicum bacteraemia: its association with occult colonic malignancy and with mycotic aneurysm formation. Clostridia isolated from blood cultures should not be dismissed as contaminants but fully identified to ensure appropriate patient management.
authors.affiliation: Department of Microbiology and Infectious Diseases, Oxford University Hospital, The John Radcliffe Hospital, Oxford, UK.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Khalid
authors.forename: Rajeka
authors.initials: R
authors.lastname: Lazarus
authors.forename: Ian C J W
authors.initials: IC
authors.lastname: Bowler
authors.forename: Chris
authors.initials: C
authors.lastname: Darby
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000382:microbiology* / Q000601:surgery; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology; D003015:Clostridium Infections / Q000150:complications* / Q000382:microbiology; D052557:Clostridium septicum; D003082:Colectomy / Q000009:adverse effects; D003106:Colon / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male