BMJ Case Reports 2017; doi:10.1136/bcr-2017-222759
  • Unusual presentation of more common disease/injury

Deadly combination: Clostridium septicum and colorectal malignancy

Editor's Choice
  1. Shona Tormey2
  1. 1 General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
  2. 2 General Surgery, University Hospital Limerick, Limerick, Ireland
  1. Correspondence to Dr Carolyn Cullinane, cc3189{at}
  • Accepted 7 November 2017
  • Published 2 December 2017


Gas gangrene is a life-threatening, necrotising soft tissue infection. Colorectal malignancy-associated Clostridiumsepticum is a rare cause of gas gangrene. This case outlines an initial presentation of colonic malignancy as gas gangrene from C.septicum infection.

A 69-year-old man presented with abdominal pain, vomiting and constipation. Abdominal X-ray revealed dilated small bowel loops. Lactate was elevated. A diagnosis of small bowel obstruction was made. Subsequent CT revealed caecal thickening and subcutaneous emphysema overlying the left flank. Clinically, he became haemodynamically unstable. Examination revealed crepitus overlying the left flank in keeping with gas gangrene. The patient required immediate surgical debridement. Tissue specimens cultured C.septicum. Following a complicated postoperative period, he was transferred to the plastic surgery team for further tissue debridement and reconstruction. A colonoscopy was later performed which was suspicious for malignancy. Colorectal multidisciplinary team discussion is awaited.


  • Contributors CC: Author and data collection. HE: Editing. ST: Editing and provision of images.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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