Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015:16:15-8.
doi: 10.1016/j.ijscr.2015.09.009. Epub 2015 Sep 18.

A rare case of symmetrical four limb gangrene following emergency neurosurgery

Pho Nh Phan  1 , Vikas Acharya  2 , Dhruv Parikh  3 , Amjad Shad  4
Affiliations

A rare case of symmetrical four limb gangrene following emergency neurosurgery

Pho Nh Phan et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: The authors report a case of symmetrical peripheral gangrene (SPG) following emergency neurosurgery.

Presentation of case: A 35-year-old female presented to hospital in Thailand with nausea, headache, and subsequent seizures. She was found to have a large intracranial space-occupying lesion with mass effect. Following emergency surgical debulking and decompression, she suffered from severe sepsis with multiple organ failure, treated with high dose intravenous vasopressors and developed secondary gangrene in all four limbs. She was repatriated to the UK with a baseline GCS of 8 and multiple postoperative medical complications. With initial conservative management, the patient made a prolonged but satisfactory progression to recovery prior to semi-elective debridement and selected digit amputation of the gangrene.

Discussion: This is the first reported case of four limb symmetrical peripheral gangrene following an emergency craniotomy.

Conclusion: Although rare, SPG is a substantial complication with high mortality and morbidity and therefore should be especially taken into account for emergency intracranial pathologies in neurosurgical patients, particularly if they require emergency surgery.

Keywords: Ischaemia; Neurosurgery; Postoperative complications; Septicaemia; Symmetrical peripheral gangrene.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Dorsal and palmar aspects of right hand.
Fig. 2
Fig. 2
Dorsal and palmar aspects of left hand.
Fig. 3
Fig. 3
Dorsal and plantar aspects of right foot.
Fig. 4
Fig. 4
Dorsal and plantar aspects of left foot.
See this image and copyright information in PMC

References

    1. Sharma B.D., Kabra S.R., Gupta B. Symmetrical peripheral gangrene. Trop. Doct. 2004;34:2–4. - PubMed
    1. Parmar M.S. Symmetrical peripheral gangrene: a rare but dreadful complication of sepsis. CMAJ. 2002;167:1037–1038. - PMC - PubMed
    1. Molos M.A., Hall J.C. Symmetrical peripheral gangrene and disseminated intravascular coagulation. Arch. Dermatol. 1985;121:1057–1061. - PubMed
    1. Hayes M.A., Yau E.H., Hinds C.J., Watson J.D. Symmetrical peripheral gangrene: association with noradrenaline administration. Intensive Care Med. 1992;18:433–436. - PubMed
    1. Johansen K., Hansen S.T. Symmetrical peripheral gangrene (purpura fulminans) complicating pneumococcal sepsis. Am. J. Surg. 1993;165:642–645. - PubMed