CASE REPORT   

Chirurgia 2022 December;35(6):377-81

DOI: 10.23736/S0394-9508.22.05357-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intestinal perforation mimicking postoperative gas gangrene: a differential diagnosis of a rare but feared surgical complication

Magdalena SACHER ¹, Valentin LADENHAUF ², Martin C. FREUND ², Reinhold KAFKA-RITSCH ¹, Irmgard E. KRONBERGER ¹, Rupert OBERHUBER ¹, Felix KRENDL ¹, Katharina ESSWEIN ¹, Christina BOGENSBERGER ¹, Stefan SCHNEEBERGER ¹, Christoph PROFANTER ¹, Dietmar ÖFNER ¹, Thomas RESCH ¹ ✉

¹ Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria; ² Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

Gas gangrene (GG) represents a rare but feared complication following abdominal surgery. Immediate diagnosis and emergency surgical debridement remains the therapy of choice. Herein we present a case in which clinical and typical computer tomographic (CT) appearance of GG was mimicked by an emphysema resulting from an intestinal perforation following laparoscopic surgery. Radiologic and clinical features are compared with a historic case of GG from our center. In March 2020, a 68-year-old male patient presented with abdominal pain and rising inflammatory parameters two days following laparoscopic cholecystectomy. A subcutaneous thoracic emphysema was suspected and confirmed by chest-X-ray. Contrast-enhanced CT-scan revealed a rapidly progressing soft tissue emphysema spreading along the thoracic and abdominal wall with dissolvement of the left pectoral muscle. Therefore, clinical and CT features fulfilled the criteria for GG described in the current literature and closely resembled the findings in a historic case of verified GG from our unit, which are presented herein. Consequently, emergency surgery was initiated. The pectoral incision confirmed the presence of emphysema but revealed no signs of necrosis. Instead, a focal intestinal wall defect with a transfascial longitudinal dissemination of bile content to the subcutaneous fat was identified as the underlying cause. As shown by this rare clinical case, seemingly typical CT-morphological and clinical signs can be mimicked by an intestinal perforation following laparoscopic surgery.

KEY WORDS: Gas gangrene; Clostridium perfringens; Tomography, X-ray computed; Laparoscopy