Reuters Health Information (2004-10-26): Fulminant gas gangrene caused death of healthy liver donor
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.