Fatal Clostridium perfringens Septicemia After Colonoscopic Polypectomy, Without Bowel Perforation

Abstract

Since its introduction, colonoscopy has played an important role as a diagnostic, therapeutic, and screening tool. In general, colonoscopy is regarded as a safe procedure, but complications may occur. The most dreaded of these complications is colonic perforation. Bacteremia postprocedure may occur, and although it is not uncommon, it rarely results in clinically significant complications. Patients with IBD (inflammatory bowel disease) are a high-risk population for bacteremia, which may leads to bowel wall overstepping by the bacteria. With regard to that, we report a fatal case of gas gangrene complicating colonoscopy polypectomy without bowel perforation in a healthy adult. To the best of our knowledge, only two other cases of retroperitoneal gas gangrene associated with colonoscopy polypectomy without bowel perforation have been described in international literature, but none of which was completed by a molecular biology analysis.

Epidemiological characteristics of postoperative sepsis

“…This study identified that pancreatic, small bowel, and splenic surgeries were associated with higher risks among patients aged 18-44, 45-64, and ≥65 years, respectively. In addition, there is much evidence claiming that postoperative sepsis was found in patients after an uncomplicated colonoscopic polypectomy, which is regarded as a safe procedure, due to unidentified abdominal infections [24,25]. These results suggest that general abdominal procedures, including not only complex surgeries but also routine procedures, pose a significant risk for the development of postoperative sepsis.…”

Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

“…The pathophysiological events underlying sepsis have a strong impact on the function of each organ [ 1 , 3 , 7 ] since the organ failure induced gives rise, in most cases, to morphological alterations that can be evaluated both macroscopically and microscopically. We start by suggesting some works describing the main post-mortem macroscopic and histological changes ( Table 1 ) detected on septic organs [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

“…The most peculiar findings were associated to septic processes sustained by specific bacteria, such as those responsible for gas gangrene. An example is reported in a case report by Gioia et al [ 20 ], where the septic process sustained by Clostridium spp. caused retroperitoneum and thigh muscles gas gangrene and iliopsoas myonecrosis, along with palpable crepitation and haemorrhagic-oedematous adipose tissues.…”

“…As summarized by Rorat et al [ 21 ], signs that can be detected, either on skin or mucosal surfaces, include abscesses, skin discolorations, rashes, or haemorrhagic lesions [ 8 , 19 ], which might testify to the development of a DIC (Disseminated Intravascular Coagulation) or the formation of septic embolisms. Sometimes, more specific lesions might help suggest the cause of sepsis, such as the presence of vesicular and erosive lesions in TEN (Toxic Epidermal Necrolysis) and SSSS (Staphylococcal Scalded Skin Syndrome), or cutaneous cellulitis (peau d’orange) and palpable crepitation in cases of gas gangrene [ 20 ].…”

“…Along with the autopsy investigations, in some of the above-mentioned works [ 8 , 10 , 15 , 19 , 20 ], as well as in other selected works further discussed [ 22 , 23 , 24 , 25 , 26 ], the authors also performed cultural assays in order to evaluate their usefulness in a post-mortem setting ( Table 2 ).…”