A rare case of gas under diaphragm due to spontaneous perforation of uterus due to gas gangrene of uterus with clostridium perfringens infection presenting as intestinal perforation
DOI:
https://doi.org/10.18203/2349-2902.isj20193362Keywords:
Gas gangrene of uterus, Clostridium perfringens infection, Air under diaphragm, Spontaneous perforationAbstract
Uterine perforation is an uncommon, perforation due to clostridium perfringens is very rare, but potentially serious complication of uterine gangrene is due to clostridial infection, uterine manipulation, evacuation of retained products, termination of pregnancy, during coil insertion and hysteroscopic procedures. We report a 60 year old female patient presented with abdominal pain, constipation and Fever with features of septic shock. X-ray showed free gas under both domes of diaphragm. CT showed gas under diaphragm and hollow viscus perforation. This report aims to alert surgeons to the possibility that perforation of uterus due to gangrene with clostridium perfringens infection also shows air under diaphragm apart from routine causes. Correct diagnosis and treatment is essential for the survival of the patients with gas under diaphragm due to gas gangrene of uterus.
References
Stroumsa D, Ben-David E, Hiller N, Hochner-Celniker D. Severe clostridial pyomyoma following an abortion does not always require surgical intervention. Case Rep Obstet Gynecol. 2011;2011:364641.
Halpin TF, Molinari JA. Diagnosis and management of clostridium perfringens sepsis and uterine gas gangrene. Obstet Gynecol Surv. 2002;57(1):53–7.
Myers RAM. Hyperbaric oxygen therapy in clostridial infection. South Med J. 1985;78:227.
Hanson GC, Slack WK, Chew HE, Thomas DA. Clostridal infection of the uterus: A review treatment with hyperbaric oxygen. Postgrad Med J. 1966;42:499.
Kurashina R, Shimada H, Matsushima T, Doi D, Asakura H, Takeshita T. Spontaneous uterine perforation due to clostridial gas gangrene associated with endometrial carcinoma. J Nippon Med Sch. 2010;77(3):166–8.
Nakamura M, Cross WR. The lecithinase (alpha toxin) activity of strains of Clostridium perfringens. Proc Soc Exp Biol Med. 1968;127:719.
Larson CM, Bubrick MP, Jacobs DM, West MA. Malignancy, mortality, and medicosurgical management of Clostridium septicum infection. Surgery. 1995;118:592.
Russell AM. The significance of Clostridium welchii in the cervical swab and blood serum in the post-partum and postabortum sepis. J Obstet Gynaec Brit Emp. 1949;56:247.
