Gas gangrene is a life-threatening infection caused by Clostridium bacteria. It develops rapidly after trauma or surgery that disrupts tissues, or through the bloodstream from the GI tract. It causes tissue death and gas formation. Symptoms include severe pain, swelling, blistering skin, and a sweet-smelling discharge from wounds. Treatment requires prompt surgical debridement of dead tissue, antibiotics like penicillin and clindamycin, and hyperbaric oxygen therapy to reduce toxins. Without aggressive treatment, it can cause sepsis, organ failure, and death.

1. Gas Gangrene
(Clostridial
Myonecrosis)

2. Gas gangrene: introduction
– It is life threatening,rapidly spreading muscle infection caused by clostridial
organisms which results in myonecrosis.
– There are basically two modes by which gas gangrene can develop:
– 1) Contiguously form area of trauma
– 2) Hematogenously form GI tract with muscle seeding

3. Aetiology
– Caused by various species of clostridium notably:
– Clostridium perfringes (most common cause in traumatic gas gangrene)
– Clostridium septicum (most common cause in spontaneous gas gangrene)
– Clostridium oedematiens
– Clostridium hemolyticum
– Clostridium sporogenes
– they are gram positive anaerobic spore producing bacteria which are found
widespread in the soil, manure, as well as in human and animal GI tract

5. Traumatic gas gangrene
common in deep penetrating injuries like
 Knife wound,
 Gun shot wound,
 Crush injuries,
 Compound fracture,
 Abortion,
 Im injection

6. Pathogenesis

7. Clinical features
– Incubation period is <24 hr but depends on size of bacterial inoculum and
extent of vascular compromise
– Sudden onset of severe pain at the site of surgery/ trauma
– Gross edema
– Other local features: Skin- pale with khaki color, tense with exquisitively tender
– Thin brownish fluid escapes which has sickly sweet odor. Why sweet?
– Overlying bullae present: red/purple
– Palpable crepitus: very imp. Finding

10. General features
– Anxious /alert
– Tachycardia and fever
– Features of septic shock including hypotension and labored breathing
– Eventually leading to multiorgan dysfunction manifesting as:
– Jaundice
– Renal failure

12. Diagnosis: definitive &
supportive
– Blood culture/ tissue culture: done in appropriate anaerobic media: shows gram
positive rod
– Histopathology: widespread tissue destruction and presence of organism but
absence of neutrophils
– Supportive:
– Radiography: Xray/CT-scan/ MRI : reveal gas in deep tissue
– Other: CBC, LFT,RFT, Chest xray : to detect complications and for assessing
extent of infection

13. Treatment: Definitive
– Primary survey: ABCDE
– Surgical debridement: prompt, aggressive and thorough surgical inspection and
debridement of devitalized tissue
– Antibiotic: Regimen: Penicilin (3-4 mil. Units every 4 hrly) PLUS clindamycin (900
mg every 8 hrly) until hemodynamic stability
– Polyvalent anti- gas gangrene serum
– Amputate, if necessary

14. supportive
– Treatment of septic shock using proper vasopressor and fluid and electrolyte
balance
– Organ support and treatment of organ failure, if any
– Hyperbaric oxygen therapy: reduce the amount of toxin produced
– Repeated blood transfusion to counteract hemolysis
– Nutritional support

15. Spontaneous gas gangrene :
predisposing factors
– ●Colonic malignancy
– ●Inflammatory bowel disease
– ●Diverticulitis
– ●Gastrointestinal surgery
– ●Leukemia
– ●Lymphoproliferative disorders
– ●Chemotherapy
– ●Neutropenia
– ●Radiation therapy
– ●AIDS

16. Diagnosis:
– Fever and severe pain in an extremity (in the absence of trauma) should raise
suspicion for spontaneous gas gangrene.

17. Management
– Exactly similar to the traumatic gangrene.