Gas gangrene presenting with back pain

Abstract

A 61-year-old Caucasian man (previously fit and well) presented to the emergency department with 2 days of non-traumatic, non-radiating lower back pain. He was admitted to our department having been provisionally diagnosed with discitis. Later that night, while being reassessed, a skin lesion on his thigh appeared and gas could be palpated. The patient was then taken immediately to theatre and a radical surgical debridement was performed. The organism that grew from tissue samples was Clostridium septicum, which when identified is an indication to exclude colonic neoplasms. The patient managed to preserve his limb on this occasion, however, he underwent a right hemicolectomy for what proved to be a colonic tumour at a later date.

Figure 1

Normal anteroposterior lumbosacral radiograph that was taken on admission to exclude any vertebral destruction due to discitis.

Figure 2

Anteroposterior pelvis radiograph with extensive gas formation taken after crepitus of the left thigh was palpated.

Figure 3

Coronal section abdominal CT scan showing bulky circumferential tumour in distal ascending colon/hepatic flexure. After Clostridium septicum grew from tissue cultures, it was an indication to exclude colonic neoplasms.