Infections of the endomyometrium by gas-producing Clostridial species can result in gas gangrene. Early diagnosis and aggressive management is necessary for patient survival.
Sources of Clostridial species:
(1) vaginal flora
(2) fecal flora
(3) environmental source
Preceding event:
(1) amniocentesis
(2) abortion
(3) vaginal or caesarian delivery
(4) uterine malignancy
(5) trauma
Clostridium perfringens is the usual cause but other species of Clostridia may be gas-producing. Culture or molecular methods are needed to identify the genus and species.
The patient may present with:
(1) fever
(2) painful uterus with or without foul-smelling discharge
(3) intramural gas within the uterus on imaging studies
(4) complications
Complications:
(1) uterine rupture with peritonitis or abscess formation
(2) hemolytic anemia due to circulating lecithinase
(3) sepsis
(4) shock with multi-organ failure
(5) disseminated intravascular coagulopathy (DIC)
Differential diagnosis:
(1) pneumopolycystic endometritis
(2) infection with another genus of gas-producing bacteria
