抄録
A case of spontaneous nontraumatic intrahepatic clostridial gas gangrene is reported. The patient, a 77-year-old male, complained of upper abdominal pain and dyspnea of abrupt onset. His general condition deteriorated rapidly and he died 2 hours after his admission. Abdominal X-P and CT showed abnormal intrahepatic gas accumulation and laboratory data revealed severe metabolic acidosis, massive hemolysis and abnormal hepatic function. A blood smear obtained at the time of death showed gram positive rods and blood culture yielded Clostridium perfringens and Escherichia coli. Autopsy findings included numerous gram positive rods in the liver, kidney, spleen, heart, bone marrow and submucosal layer of the G-I tract, and microabscess of the liver was noted. However, inflammatory cell infiltration was absent from all involved organs. These virulent clinical findings are specific to clostridial gas gangrene and are considered to be brought about by the production of clostridial exotoxins (especially α-toxin and θ-toxin). Infection progresses in a highly fulminant manner and the prognosis is much poorer than traumatic clostridial gas gangrene; the majority of patients die within 24 hours after onset. The reason for the high mortality rate is failure to make the diagnosis in the early stages, as early diagnosis and treatment are crucial.
