Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature

Table 1 Timeline of information from this case report

Date	Time	Major event	Treatment
3/31/2017	-	Fall from a high height	Admitted to another hospital
4/1/2017	-	Severe abdominal distension and unbearable abdominal pain	Transferred to our hospital
	14:30	Shock	Anti-shock therapy
	18:00	Abdominal CT showed pneumoperitoneum, ascites and portal venous gas	Emergency laparotomy
	18:00-23:50	First operation; crepitus and snow-ball crepitation were obvious between the greater omentum layers	Intraoperative bacterial smear; ICU life support after surgery
4/2/2017	1:00	Suspected gas gangrene	Antibiotic therapy with penicillin, sulperazon and ornidazole
	1:20	Critical values in coagulation tests were reported	Plasma transfusion
	10:00	A large number of Gram-positive bacilli found in pus smear	Open abdomen
4/3/2017	7:30	Critical values in coagulation tests were reported	Plasma transfusion
4/4/2017	10:00	Clostridium perfringens cultured in drainage fluid	Continued antibiotic therapy
4/7/2017	9:00	Intestinal contents were found in abdominal drainage fluid	Second operation
4/11/2017	9:00	Multidrug-resistant bacteria were found in sputum culture	Added imipenem to antibiotic therapy
	10:00	Clostridium perfringens culture negative	-
	12:00	Intestinal contents found in abdominal drainage fluid	Third operation
4/12/2017	10:00	Clostridium perfringens culture negative; patient regained consciousness	-
4/13/2017	10:00	Clostridium perfringens culture negative; restored enteral nutrition; SBT experiment implemented	Discontinued penicillin; extubated
4/14/2017	10:00	Enterococcus faecium found in sputum culture	Replaced other antibiotics with vancomycin
4/21/2017	15:30	Fascial closure	-
4/24/2017	15:00	Patient transferred to general ward	Antibiotics downgraded to Cefoxitin
4/27/2017	10:00	Escherichia coli cultured from peritoneal drainage fluid	Antibiotics replaced with sulperazon and amikacin
5/1/2017	10:00	Patient able to move with protective gear	Removed abdominal drainage tube
5/12/2017	10:00	Patient discharged	-
5/30/2017	-	Patient developed progressive myasthenia	Diagnosed with Guillain-Barre syndrome
6/14/2017	-	Patient died of respiratory failure	-

CT: Computed tomography; ICU: Intensive care unit; SBT: Small bowel transit.