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Gas gangrene

Last updated: May 22, 2025

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Diagnostic approach

Gas gangrene is a clinical diagnosis; do not delay treatment to perform diagnostic studies.

Management checklist

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Summarytoggle arrow icon

Gas gangrene or clostridial myonecrosis is a life-threatening necrotizing soft tissue infection most commonly caused by the rapid proliferation and spread of Clostridium perfringens. Traumatic gas gangrene occurs in wounds with compromised blood supply, while spontaneous gas gangrene occurs from hematogenous spread from lesions in the gastrointestinal tract. Gas gangrene manifests with excruciating muscle pain, edema with subsequent skin discoloration (red-purple to black), and signs of sepsis. Gas production leads to crepitus and a feathering pattern of gas on imaging. Treatment involves immediate surgical debridement with removal of all necrotic tissue in combination with antibiotic therapy. Even with treatment, gas gangrene has a high mortality rate.

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Etiologytoggle arrow icon

Traumatic gas gangrene [1]

Spontaneous gas gangrene [2]

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Pathophysiologytoggle arrow icon

Ubiquitous C. perfringens spores contaminate a wound OR C. septicum spreads hematogenously from lesions in the gastrointestinal tract → bacterial reproduction under anaerobic conditions ↑ secretion of exotoxins, especially C. perfringens alpha-toxin (a phospholipase lecithinase) → degradation of phospholipids → tissue destruction (myonecrosis), inhibition of leukocyte function, and gas production gas separation into healthy tissue → further colonization and more local tissue destruction further exacerbation of anaerobic conditions by the development of edema

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Clinical featurestoggle arrow icon

Gas gangrene is a medical emergency that can rapidly progress to multiorgan failure.

Perfringens perforates: C. perfringens causes gas gangrene that leads to severe tissue damage.

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Pathologytoggle arrow icon

Histopathological findings include: [3]

  • Myonecrosis and destruction of surrounding degenerative tissue (muscle, fat, subcutaneous tissue)
  • Pathogens without inflammatory infiltrate
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Diagnosistoggle arrow icon

Gas gangrene is a clinical diagnosis; do not delay treatment to perform diagnostic studies.

Approach [1][2][4]

  • Perform a septic workup.
  • Obtain imaging for diagnostic uncertainty and/or to assess extent of infection.
  • Confirm the diagnosis with surgical exploration and microbiological studies.

Laboratory studies [1][2]


Imaging [2][4]

  • Modalities: ultrasound, x-ray, CT, or MRI depending on availability and patient stability
  • Findings: characteristic feathering pattern of the soft tissue caused by gas pockets between muscle fibers

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Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

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Treatmenttoggle arrow icon

Initial management [4][6]

Gas gangrene requires prompt surgical exploration and debridement.

Antibiotic therapy [6][7]

Surgical and wound management [2][6]

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Prognosistoggle arrow icon

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