Clinical

Fulminant gas gangrene caused death of healthy liver donor

Last Updated: 2004-10-26 14:23:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - According to a report published this month, fulminant gas gangrene of the stomach was determined to be the cause of death in a highly publicized case of a man who died at Mount Sinai Hospital in New York after donating a portion of his liver to his brother.

In January 2002, a 57-year-old man with a history of hypercholesterolemia and anxiety, but was otherwise healthy, volunteered to donate his right hepatic lobe to his brother.

The surgery and postoperative course were uneventful until the evening of postoperative day 2, when he developed nausea and hiccups. The patient was given metoclopramide and later Thorazine.

Early the next day, he was without complaints and sat in a chair. Within a few hours, however, he developed rapidly worsening tachycardia, hypotension, and coffee-ground emesis. Despite efforts to resuscitate him, the patient died.

"Autopsy demonstrated gas gangrene of the stomach as the underlying cause of the hemorrhage and numerous colonies of Gram-positive bacilli were identified," the team that cared for the patient reports in the October issue of Liver Transplantation. The bacteria were later identified as Clostridium perfringens type D.

The lead author of the case report is Dr. Charles M. Miller, now chief of liver transplantation at the Cleveland Clinic Foundation in Ohio. On the first day after surgery the patient was feeling so well that he asked his family to bring him takeout food from a local restaurant, Dr. Miller and colleagues report. They speculate that "it is most likely that infection resulted from bacteria in the lobster dinner" from the restaurant, based on the typing of the Clostridia.

"Surgical stress, relative portal hypertension, and subsequent acute gastropathy with an alkaline environment induced by the H2 blocker most likely increased the stomach's susceptibility to Clostridia," they add.

In the year following this patient's catastrophic death the number of living donor liver transplants in the United States fell by 30% compared with the year before, as a result of "national and international media furor, and the rumors and speculations generated in the medical community and the general public."

Now, Dr. Miller and his colleagues write, "We have presented the facts. This case represents an extraordinary example of florid clostridial infection and toxin-mediated shock."

"Whether or not this death was preventable will remain unknown," the authors conclude. "As a result of this case, however, it is reasonable to recommend prolonged nasogastric decompression and avoidance of oral intake in the early postoperative period, and acid-blocking medications should probably be discontinued just prior to resuming a regular diet."

Liver Transpl 2004;10:1315-1319.