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From question on page 965

The radiographs show extensive gas in the soft tissue due to gas gangrene. The differential diagnosis includes clostridial gas gangrene, streptococcal fascitis, bacteroides infection, and mechanical trauma. As this patient had developed necrotising fascitis, fasciotomy was the appropriate procedure.

Unfortunately, this patient did not survive the procedure. Autopsy revealed carcinoma of the ascending colon and blood cultures grew Clostridium histolyticum. Clostridial myonecrosis is most commonly seen as a complication of heavily contaminated wounds. Spontaneous clostridial myonecrosis has been described in association with colorectal malignancies, haematological malignancies, diabetes, and radiation colitis. Clostridium perfringens and septicum are the most frequent causative organisms. Gram stain of the wound drainage is a rapid way of confirming the diagnosis. As disease is associated with a high mortality (80%), rapid diagnosis and treatment is essential. Antibiotics and surgical debridement remain essential components. Hyperbaric oxygen therapy has been tried with varying degree of success.

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