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An Unusual Fatal Outcome of Laparoscopic Cholecystectomy: A Case Report
Catarina Osório1, Diogo Silva1, Luís Teles2
1General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT.
Abstract:
Clostridium perfringens (C. perfringens) and Klebsiella oxytoca (K. oxytoca) are pathogenic human bacteria. Clostridium perfringens sepsis with intravascular hemolysis is a catastrophic process with an extremely high mortality rate (70 to 100%). A 74-year-old male submitted to an elective laparoscopic cholecystectomy due to cholelithiasis and develops severe abdominal pain only 10 hours after being discharged from hospital. He was admitted to the emergency department with associated jaundice, fever, and hematuria. On arrival, his hemoglobin level was 9.2 g/dL but fell to 3.4g/dL within two hours. Massive intravascular hemolysis was diagnosed and a liver abscess with gas gangrene was shown in the contrast-enhanced computed tomographic. Despite proper management, a fatal outcome was unavoidable and the patient died eight ours later. Microbiological examination isolated C. perfringens and K. oxytoca. Liver abscesses caused by C. perfringens and K. oxytoca are extremely rare complications of laparoscopic cholecystectomy. Early recognition and prompt antibiotic therapy as well as control of septic focus are essential to minimize this fatal outcome.
Insights
Clostridium perfringens sepsis with intravascular hemolysis is a rare but fatal complication. This case highlights the extreme danger of Clostridium perfringens and Klebsiella oxytoca liver abscesses following laparoscopic cholecystectomy.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Surgical Complications
Background:
- Clostridium perfringens (C. perfringens) sepsis with intravascular hemolysis carries a 70-100% mortality rate.
- Laparoscopic cholecystectomy is a common procedure for cholelithiasis.
- Pathogenic bacteria like C. perfringens and Klebsiella oxytoca (K. oxytoca) can cause severe infections.
Observation:
- A 74-year-old male developed severe abdominal pain, jaundice, fever, and hematuria 10 hours post-discharge after laparoscopic cholecystectomy.
- Rapid drop in hemoglobin from 9.2 g/dL to 3.4 g/dL indicated massive intravascular hemolysis.
- Contrast-enhanced CT revealed a liver abscess with gas gangrene.
Findings:
- Microbiological examination isolated both C. perfringens and K. oxytoca.
- The patient experienced a fatal outcome despite prompt management.
- Liver abscesses caused by these bacteria are exceedingly rare post-laparoscopic cholecystectomy.
Implications:
- This case underscores the critical need for early recognition of C. perfringens and K. oxytoca infections.
- Prompt antibiotic therapy and source control are vital for managing such rare but severe complications.
- Minimizing mortality requires swift intervention in cases of post-cholecystectomy sepsis with hemolysis and liver abscess.
