Gas gangrene

Last updated: May 11, 2023

Summarytoggle arrow icon

Gas gangrene (also known as clostridial myonecrosis) is a life-threatening necrotizing soft tissue infection commonly caused by the rapid proliferation and spread of Clostridium perfringens from a contaminated wound. The clinical picture includes excruciating muscle pain, edema with subsequent skin discoloration (red-purple to black) and gas production. Crepitus, as well as a feathering pattern of gas in soft tissue imaging, are generally present. Without treatment, gas gangrene is fatal in almost 100% of cases. Surgical debridement in combination with antibiotic therapy reduces this figure by half.

Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

Ubiquitous C. perfringens spores contaminate a wound → 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

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.

Subtypes and variantstoggle arrow icon

Spontaneous gas gangrene

Diagnosticstoggle arrow icon

  • Imaging: Radiography, CT, or MRI typically show a characteristic feathering pattern of the soft tissue.
  • Laboratory tests
  • Surgical exploration
    • Affected muscle does not bleed or contract, and may be pale or discolored red-purple to black.
    • Histopathological findings of biopsy [1]
      • Myonecrosis and destruction of surrounding degenerative tissue (muscle, skin fat, subcutaneous tissue)
      • Presence of pathogens; without inflammatory infiltrate

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

The most important steps of management are immediate surgical debridement and antibiotic therapy. Patients should receive supportive therapy and intensive care.


Prognosistoggle arrow icon

  • Mortality rate [3]
    • Untreated: ∼ 100%
    • With appropriate treatment: 20–30%

Referencestoggle arrow icon

  1. Stevens DL, Bryant A. Clostridial myonecrosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: May 12, 2016. Accessed: September 20, 2016.
  2. Buboltz JB, Murphy-Lavoie HM. Gas Gangrene. StatPearls. 2020.
  3. Miller ML. Causes of rhabdomyolysis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: September 19, 2014. Accessed: September 22, 2016.

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