Abstract
We present a case of Aeromonas sobria infection followed a drastic course after cholecystectomy under laparotomy. The case involved a 66-year-old man who underwent endoscopic sphincterotomy (EST) for cholangitis caused by spilled gallstones. He was indicated cholecystectomy to prevent recurrence. During surgery, a slight degree of contamination due to exudation of bile juice occurred, but the surgery was completed after lavage of the surgical field according to the usual procedure. About 35 hours after the operation, he suddenly went into shock. CT scan revealed gases in the muscle layer and subcutaneous structure at the surgical wound. Opening of the wound up to the sutured fascia produced a fluid discharge with a saprogenic odor. Aeromonas sobria was isolated from the blood, wound and stool. Lavage, administration of broad-spectrum antibiotics, circulatory and respiratory management, and hemocatharsis were unsuccessful, and the patient died of multi-organ failure due to sepsis. This patient had daily drunk water from a well so that he had carried the microorganism which ranges all over the natural water. Accordingly it is inferred that the microorganism had been latent in the biliary tract under the influence of EST. As wound infection caused by this microorganism is characterized by to be life-threatening abruptly, attention must be paid to the importance of asking whether the patient drinks well water or not before gastrointestinal surgeries.
