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RETROPERITONEAL GAS GANGRENE
BORIS DELIĆ
orcid.org/0000-0001-9183-8121
; Dubrava University Hospital, Department of Emergency and Intensive Medicine, Zagreb, Croatia
MAŠA SORIĆ
; Dubrava University Hospital, Department of Emergency and Intensive Medicine, Zagreb, Croatia
SEAD ŽIGA
; Dubrava University Hospital, Department of Emergency and Intensive Medicine, Zagreb, Croatia
WILMA MILETIĆ
; Dubrava University Hospital, Department of Emergency and Intensive Medicine, Zagreb, Croatia
TEA BARŠIĆ GRAČANIN
; Dubrava University Hospital, Department of Emergency and Intensive Medicine, Zagreb, Croatia
VLATKO GRABOVAC
; Dubrava University Hospital, Department of Emergency and Intensive Medicine, Zagreb, Croatia
Abstract
Gas gangrene or clostridial myonecrosis is a life-threatening infection and destruction of healthy muscle tissue that develops after trauma (traumatic) or by hematogenous spread from the gastrointestinal tract (spontaneous). Early recognition and aggressive treatment are of utmost importance. Pain at the site of traumatic injury combined with signs of systemic toxicity and the presence of gas in the soft tissue support the diagnosis of gas gangrene. On clinical examination, crepitations in soft tissues are the most sensitive and specifi c sign, and radiological imaging is also a useful diagnostic tool. On differential diagnosis, polymicrobial necrotizing soft tissue infection should be distinguished from gas gangrene. We present a case of a 44-year-old female who presented to the emergency department with pain in her left hip and knee, felt for several days back. She explicitly denied trauma or other signifi cant illness at the time of examination. Her personal history revealed that she had been treated for breast cancer 9 years before, had undergone surgery and chemotherapy. The x-ray of her left hip and knee showed left coxarthrosis. Eventually, the patient was discharged home after receiving intramuscular diclofenac 75 mg in the left gluteus, with instructions to report to the orthopedic outpatient clinic, and in case of deterioration, to the emergency room. Seven days later, the patient presented to our emergency room because of diffi culty breathing, fever up to 39 °C, poor general condition, and swelling of the left ankle and lower leg. After diagnostic workup, highly elevated infl ammatory parameters were verifi ed and multi-slice computed tomography of the abdomen showed gas gangrene of the left retroperitoneum and muscles of the left side of the pelvis and left proximal femur. Abdominal surgeon and traumatologist were promptly consulted and empirical parenteral antibiotic therapy and emergency surgery under general anesthesia were indicated. The postoperative course was without major complications and one year after the procedure, the patient felt well. This case report shows that a seemingly benign clinical presentation can lead to life-threatening complications and clinical deterioration in just a few days. The timely and appropriate response of the emergency room physician was crucial, where soon after the diagnosis, the patient underwent radical and aggressive surgical treatment and antibiotic therapy, thus preventing and avoiding a signifi cant adverse or even lethal outcome.
Keywords
emergency department; gas gangrene; necrotizing fasciitis; sepsis
Hrčak ID:
236631
URI
Publication date:
16.3.2020.
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