Postoperative Bacterial Synergistic Cellulitis of Abdominal Wall

Abstract

In this era of antibiotics and chemotherapeutic agents the incidence of postoperative wound infections has been reduce to a negligible percentage. This is due not only to these new agents but also to improvement in the efficiency of personnel, sterilization of instruments and fields, and improved surgical techniques that follow the basic concepts of good surgery and good tissue care. Against this background, there occur, rarely, certain infectious complications of normal surgical treatment. These complications, at first slow-moving, are insidious, relentless, and almost totally resistant to the usual modes of treatment. All concerned, the surgeon, the physician, the bacteriologist, and the pathologist, may well conclude that much is yet to be done in the field of bacteriology in assessing the specific organism or organisms causing such an infection and in determining the best specific therapy to combat them.All types of chronic gangrene, although characterized by certain differences, are caused by special combinations of organisms. They may be conveniently classified as follows:1 (a) postoperative progressive bacterial synergistic gangrene of the abdominal or chest wall, (b) gangrenous impetigo or ecthyma, (c) fusospirochetal in¬ fection of the skin, and (d) amebic infection of the skin.We are concerned with the first type as it affects the ab¬ dominal wall. This type of infection, due to an unusual synergism, has been described by Meleney,2 Mester,3 Brewer and Meleney,4 Carroll,5 Lichtenstein,6 Dodd,7 and Bassow.8 Vier 9 has pointed out that it may be seen but once or twice in the experience of the average sur¬ geon; he states, "... but when it does occur, it is so devas¬ tating to patient and distressing to surgeon that one is im¬ pressed with the importance of its early diagnosis and treatment." Cultures taken from such a gangrenous area contain microaerophilic nonhemolytic streptococci asso¬ ciated with hemolytic micrococcus pyogenes aureus.The purpose of this paper is to report a case of a post¬ operative progressive inflammation of the anterior ab¬ dominal wall, in many ways similar to and as distressing as the gangrenous form. The infection was manifested grossly as an intense edematous type of cellulitis, with no evidence of gangrene. An anaerobic Streptococcus and a gram-positive hemolytic aerobic Bacillus identified as B. subtilis were isolated from the tissue. Injection of these organisms in combination into animals produced a similar tissue lesion. REPORT OF A CASEA 37-year-old white man was admitted to the Jewish Hos¬ pital Nov. 6, 1945, with the chief complaint of a hernia of 20 years' duration. The patient had first noticed a lump in the right groin. This lump had enlarged progressively over the course of years, and for the last 10 years the patient had been wearing a supportive truss. He had no other complaints refer¬ able to this local area. There were no gastrointestinal, genito¬ urinary, or musculoskeletal symptoms. None of the other systems were contributory to his condition. The patient had b...