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GAS GANGRENE
DR.R.DURAI MS
ASSISTANT PROFESSOR
DEPT. OF GENERAL SURGERY
MGMCRI
What is a Gangrene?
 localized cell death by obstructed circulation with
superadded bacterial infection.
2
08-02-2016GAS ...
What is a Gas Gangrene?
 Gangrene produced gas producing organisms like
Clostridium perfringens(welchii)
 Oedematous myo...
4
08-02-
2016
GAS GANGRENE BY DR.R.DURAI MGMCRI
Source of Infection
 Contaminated, manured or cultivated soil, intestines
 Faecal flora
 Crush wounds
 War wounds
 An...
Organisms
 Clostridium welchii (perfringens): Gram-positive, central
spore bearing, nonmotile, capsulated organisms
 Clo...
7
08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
TOXINS
 Alpha (most common)
 Beta
 Epsilon
 Iota
 Phi toxin—myocardial depressant
 Kappa toxin—destruction of connec...
EXOTOXINS
 Lecithinase
 Haemolysin
 Hyaluronidase
 Proteinase
9
08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
EFFECTS
 Anaerobic myositis/myonecrosis. – Hydrogen Sulphide gas
–black/ brown muscle
 Extensive spread – thoracic & abd...
Clinical Features
 Incubation period is 1-2 days
 Toxaemia
 Fever
 Tachycardia
 Pallor
11
GAS GANGRENE BY DR.R.DURAI ...
Contd…
 Wound is under tension with foul smelling discharge (sickly
sweety/decaying apple odour).
 Khaki brown coloured ...
Clinical Types
 Fulminant type
 Massive type
 Group type
 Single muscle type
 Subcutaneous type
13
08-02-2016GAS GANG...
Investigations
 X-ray
 LFT ,RFT, ABG
 CT
 Gram Stain
 Robertson’s Cooked meat media – meat to turn pink with
sour sme...
Complications
 Septicaemia, toxaemia.
 Renal failure, liver failure.
 Circulatory failure, DIC, secondary infection.
 ...
Treatment
 Injection benzyl penicillin 20 lacs 4th hourly + Injection
metronidazole 500 mg 8th hourly + Injection
aminogl...
Contd…
 Radical Wound Debridement
 Rehydration
 Amputation
 Ventilator support
 Fumigation of theatre after treatment...
18
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Gas gangrene 8 - 2- 16

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A ppt on gas gangrene

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Gas gangrene 8 - 2- 16

  1. 1. GAS GANGRENE DR.R.DURAI MS ASSISTANT PROFESSOR DEPT. OF GENERAL SURGERY MGMCRI
  2. 2. What is a Gangrene?  localized cell death by obstructed circulation with superadded bacterial infection. 2 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  3. 3. What is a Gas Gangrene?  Gangrene produced gas producing organisms like Clostridium perfringens(welchii)  Oedematous myonecrosis – Skeletal muscle  Malignant edema 3 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  4. 4. 4 08-02- 2016 GAS GANGRENE BY DR.R.DURAI MGMCRI
  5. 5. Source of Infection  Contaminated, manured or cultivated soil, intestines  Faecal flora  Crush wounds  War wounds  Anaerobic environment 5 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  6. 6. Organisms  Clostridium welchii (perfringens): Gram-positive, central spore bearing, nonmotile, capsulated organisms  Clostridium oedematiens.  Clostridium septicum.  Clostridium histolyticum. 6 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  7. 7. 7 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  8. 8. TOXINS  Alpha (most common)  Beta  Epsilon  Iota  Phi toxin—myocardial depressant  Kappa toxin—destruction of connective tissue and blood vessels  Bursting factor and circulating factor 8 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  9. 9. EXOTOXINS  Lecithinase  Haemolysin  Hyaluronidase  Proteinase 9 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  10. 10. EFFECTS  Anaerobic myositis/myonecrosis. – Hydrogen Sulphide gas –black/ brown muscle  Extensive spread – thoracic & abdominal wall  Foaming Liver 10 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  11. 11. Clinical Features  Incubation period is 1-2 days  Toxaemia  Fever  Tachycardia  Pallor 11 GAS GANGRENE BY DR.R.DURAI MGMCRI 08-02-2016
  12. 12. Contd…  Wound is under tension with foul smelling discharge (sickly sweety/decaying apple odour).  Khaki brown coloured skin  Crepitus  Jaundice ,oliguria  Frequent sites are adductor region of the lower limb and buttocks and subscapular region in upper limb. 12 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  13. 13. Clinical Types  Fulminant type  Massive type  Group type  Single muscle type  Subcutaneous type 13 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  14. 14. Investigations  X-ray  LFT ,RFT, ABG  CT  Gram Stain  Robertson’s Cooked meat media – meat to turn pink with sour smell and acid reaction.  Nagler reaction. 14 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  15. 15. Complications  Septicaemia, toxaemia.  Renal failure, liver failure.  Circulatory failure, DIC, secondary infection.  Death occurs in critically ill patients. 15 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  16. 16. Treatment  Injection benzyl penicillin 20 lacs 4th hourly + Injection metronidazole 500 mg 8th hourly + Injection aminoglycosides (if blood urea is normal) or third generation cephalosporins or metronidazole.  Fresh blood transfusion  Polyvalent antiserum 25,000 units given intrav enously after a test dose and repeated after 6 hours  Hyperbaric oxygen 16 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
  17. 17. Contd…  Radical Wound Debridement  Rehydration  Amputation  Ventilator support  Fumigation of theatre after treatment 17 08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
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