We report here on a fatal case of abdominal gas gangrene. Two days after gastrectomy, a 56-year-old man presented with intractable abdominal pain and fever of a sudden onset, which quickly progressed over several hours to septic shock. Despite of the unexplained gas collections in the abdominal muscle, fascia, and subcutaneous layers on computed tomography scan, its clinical significance was overlooked. Emergency laparotomy was initially scheduled because of concern that there may have been a perforated viscus. At the time of monitoring for the anesthesia, we noticed marbled skin discoloration and the subcutaneous emphysema had spread on his flank. Shortly after the initial suspicion of gas gangrene, cardiac arrest developed during the arterial line cannulation. Despite prompt resuscitation measures, including the administration of catecholamines and the application of extracoporeal membrane oxygenation, he eventually died. Anesthesiologists need to understand this fulminant disease because extensive debridement under general anesthesia is essential for the treatment of abdominal gas gangrene.
Abdominal Muscles ; Abdominal Pain ; Anesthesia ; Anesthesia, General ; Catecholamines ; Catheterization ; Debridement ; Emergencies ; Fascia ; Fever ; Gas Gangrene ; Gastrectomy ; Heart Arrest ; Humans ; Laparotomy ; Membranes ; Middle Aged ; Oxygen ; Resuscitation ; Shock, Septic ; Skin ; Subcutaneous Emphysema ; Vascular Access Devices

Moderate to severe pulmonary hypertension, mean pulmonary arterial pressure (mPAP) > 35 mmHg, in cirrhotic patients is usually considered an absolute contraindication to orthotopic liver transplantation (OLT) because of unacceptably high mortality. We present the case of successful OLT in a cirrhotic patient with a mPAP of 42 mmHg and a pulmonary vascular resistance (PVR) of 298 dyne . sec . cm(-5) preoperatively. He was treated with oral sildenafil (Viagra(R)) and inhaled iloprost (Ventavis(R)) for 45 days and then his mPAP and PVR were reduced to 33 mmHg and 206 dyne . sec . cm(-5) at the time of transplantation. During OLT, his mPAP was stable of 28?38 mmHg with the combined use of sildenafil via a nasogastric tube and iloprost via a nebulizer. His hemodynamic parameters were stable and significant postoperative bleeding was not noticed throughout his stay in the intensive care unit. Thereafter, he was transferred to general ward without any cardio-respiratory problems on 7th postoperative days.
Arterial Pressure ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension ; Hypertension, Pulmonary ; Iloprost ; Intensive Care Units ; Liver ; Liver Transplantation ; Nebulizers and Vaporizers ; Patients' Rooms ; Piperazines ; Purines ; Sulfones ; Transplants ; Vascular Resistance ; Sildenafil Citrate