Autopsy and Case Reports
Autopsy and Case Reports
Autopsy Case Report

Primary abdominal gas gangrene: a report of two autopsy cases

George S. Stoyanov; Deyan L. Dzhenkov; Lilyana Petkova

Downloads: 4
Views: 969


Primary hepatic gas gangrene is a form of primary abdominal gas gangrene. The condition is caused by Clostridium perfringens, other clostridia, and non-clostridia bacterial species producing gas. Unlike classical gas gangrene or myonecrosis, the disease develops without a wound or a port of entry. Instead, gas-producing bacteria in the gastrointestinal tract colonize an underlying pathological process with foci of necrosis, producing excessive gas and spreading hematogenously to other organs. Herein we present two autopsy cases of primary hepatic gas gangrene diagnosed on autopsy, with the gross and histological changes that can be considered specific for this rare condition. Both patients had severe underlying liver disease-prone for this entity development. The gross changes in the cases are postmortem subcutaneous emphysema, skin bullae with pooled blood, pneumothorax, pneumoabdomen, abundant gas in the circulatory system, porous structure of the internal organs (tissue gas bubbles), and advanced tissue lysis, not corresponding to the post mortem time. Histology showed optically empty areas of varying size in the internal organs, which weave the structure of the organs and rod-shaped bacteria with scarcity or complete absence of inflammatory reaction.


Gas Gangrene, Abdomen, Clostridium, Liver, Histology, Pathology, Autopsy


1 Buboltz JB, Murphy-Lavoie HM. Gas gangrene. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 June 4]. Available from:

2 Caplan ES, Kluge RM. Gas gangrene: review of 34 cases. Arch Intern Med. 1976;136(7):788-91. PMid:180918.

3 Meyns E, Vermeersch N, Ilsen B, Hoste W, Delooz H, Hubloue I. Spontaneous intrahepatic gas gangrene and fatal septic shock. Acta Chir Belg. 2009;109(3):400-4. PMid:19943601.

4 Tsokos M, Schalinski S, Paulsen F, Sperhake JP, Püschel K, Sobottka I. Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases. Int J Legal Med. 2008;122(1):35-41. PMid:17370083.

5 Angelov A. Clinical Pathology of infectious diseases. In: Velev G, Mihaylov I, editors. Textbook of Clinical Pathology. 2nd ed. Sofia: Znanie Ltd.; 1997. p. 299-346. Bulgarian.

6 Yashida M, Ryu M, Watanabe K, et al. An autopsy case of clostridial gas gangrene of the liver. Jpn J Gastroenterol Surg. [Internet]. 1992 [cited 2021 June 4];25:2181-5. Available from:

7 Takeyama M, Mori H, Nagareda T, et al. A case of nontraumatic clostridial gas gangrene occurring in a patient with colon adenocarcinoma, liver cirrhosis, and diabetes mellitus. Acta Pathol Jpn. 1986;36(5):757-64. PMid:3739709.

8 Sasaki T, Nanjo H, Takahashi M, Sugiyama T, Ono I, Masuda H. Non-traumatic gas gangrene in the abdomen: report of six autopsy cases. J Gastroenterol. 2000;35(5):382-90. PMid:10832675.

9 Kuroda S, Okada Y, Mita M, et al. Fulminant massive gas gangrene caused by Clostridium perfringens. Intern Med. 2005;44(5):499-502. PMid:15942103.

10 Miyata Y, Kashiwagi H, Koizumi K, et al. Fatal liver gas gangrene after biliary surgery. Int J Surg Case Rep. 2017;39:5-8. PMid:28783522.

11 Clark MA, Worrell MB, Pless JE. Postmortem changes in soft tissues. In: Haglund W, Sorg M, editors. Forensic taphonomy: the postmortem fate of human remains. Boca Raton: CRC Press; 1997. p. 156-64.

12 Carman RJ, Sayeed S, Li J, et al. Clostridium perfringens toxin genotypes in the feces of healthy North Americans. Anaerobe. 2008;14(2):102-8. PMid:18353695.

13 Ngo JT, Parkins MD, Gregson DB, et al. Population-based assessment of the incidence, risk factors, and outcomes of anaerobic bloodstream infections. Infection. 2013;41(1):41-8. PMid:23292663.

14 Watanabe N, Kobayashi K, Hashikita G, et al. Hepatic gas gangrene caused by Clostridium novyi. Anaerobe. 2019;57:90-2. PMid:30953694.

15 Doblecki-Lewis S, Palaios E, Bejarano PA, Tzakis AG, Selvaggi G, Morris MI. Hepatic gas gangrene following orthotopic liver transplantation: three cases treated with re-transplantation and a review of the literature. Transpl Infect Dis. 2008;10(4):280-5. PMid:18069931.

16 Hadem J, Westerkamp V, Trautwein C, Winkler M, Manns MP, Hafer C. Hepatic gas gangrene following liver transplantation. Liver Transpl. 2007;13(3):468-9. PMid:17318863.

17 Kitterer D, Braun N, Jehs MC, Schulte B, Alscher MD, Latus J. Gas gangrene caused by clostridium perfringens involving the liver, spleen, and heart in a man 20 years after an orthotopic liver transplant: a case report. Exp Clin Transplant. 2014;12(2):165-8. PMid:23962047.

Submitted date:

Accepted date:

Publication date:

614cc8b6a9539539882864c3 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections