A Rare Case of Uterine Gas Gangrene with Septic Abortion

Clostridium perfringens (CP), an anaerobic Gram-positive bacillus, is found among the normal human intestinal and vaginal flora in approximately 1 to 27% of healthy women so ascending infection from the vagina to uterus may occur [1,2]. It is also found in 10 to 27% of patient undergoing elective abortion [2]. Clostridium infection resulted from septic abortion, with a reported incidence between 0.5 and 1.0 % [3] it is often associated with caesarean sections and incomplete pregnancies. Injured and necrotic tissue in the uterus after delivery permits bacterial incubation and overgrowth of bacterial colonies [1]. Occasionally, CP infection can progress to gas gangrene, a form of tissue death, and may eventually lead to sepsis [3]. Most reported cases of intrauterine Clostridium infection resulted from septic abortion, with a reported incidence between 0.5 and 1.0% [2,3]. Infections due to CP show evidence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene, which is also known as clostridial myonecrosis. The involved skin is initially pale and edematous and will progress to a bronze or magenta color, followed by a blue-black color with the formation of bullae. The bullae contain a clear or hemorrhagic discharge, sometimes with a ‘‘foul-sweet’’ odor. Pain and tenderness to palpation are usually disproportionate to the wound’s appearance. In the case of uterine gas gangrene, onset is usually sudden with symptoms and signs consisting of fever, tachycardia, hypotension, renal failure, and jaundice. Radiography or other imaging may demonstrate gas in the uterine wall. Crepitus may be demonstrated on physical examination but may also be masked by significant edema. The urine often has a ‘‘port wine’’ color due to hemoglobinuria [3].