Metastatic clostridial myonecrosis secondary to perforated metastatic bowel cancer

Abstract

Spontaneous metastatic clostridial myonecrosis is a rare condition caused by Clostridium septicum. The underlying lesion is usually either a colonic neoplasm or leukemia. The authors reported a 67-year-old female who presented with acute abdomen secondary to a perforated sigmoid cancer and who developed gas gangrene in her right leg. Unfortunately, despite all resuscitative measures, she died. The authors reviewed the literature; the diagnosis of metastatic myonecrosis was based on a high index of suspicion, development of bullae containing gram-positive rods, and subcutaneous crepitus (although this was a late sign). Treatment involves aggressive fluid replacement, high doses of intravenous penicillin, high concentration of oxygen, and surgical debridement, and/or amputation. The mortality remains very high, despite all the above measures.

Keywords

Metastatic gangrene / perforated sigmoid cancer / myonecrosis / clostridia

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