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Gastroenterology
Severe septic cholangitis and pancreatitis with Clostridium perfringens: a rare but fatal complication after ERCP
  1. Rahel Vera Cola1,
  2. Peter Schreiber2,
  3. Christoph Schlag1 and
  4. Gerhard Rogler1
  1. 1Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
  2. 2Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Rahel Vera Cola; rahelstruchen{at}gmail.com

Abstract

This case describes a patient treated with elective repeat endoscopic retrograde cholangiopancreatography (Re-ERCP). In the subsequent postinterventional course, the patient developed severe abdominal pain, followed by a rapid deterioration in the overall condition, resulting in circulatory instability. Despite the immediate initiation of antibiotic therapy, the patient’s general condition deteriorated progressively with persisting catecholamine dependency, escalating lactic acidosis and radiologic identification of air within the pancreas parenchyma and the splenic vein as well as along the surrounding tissues, leading ultimately to the patient’s death.

Postmortem, Clostridium perfringens was detected within the pancreatic parenchyma and blood cultures, establishing the diagnosis of post-ERCP pancreatitis complicated by severe C. perfringens cholangiosepsis.

One of many possible pathogens of cholangitis, a rare but serious complication of ERCP, is C. perfringens. Infections due to C. perfringens show evidence of tissue necrosis, bacteraemia, emphysematous cholecystitis and gas gangrene, also known as clostridial myonecrosis.

  • Biliary intervention
  • Infections
  • Gas/Free Gas
  • Endoscopy
  • Pancreatitis

https://doi.org/10.1136/bcr-2024-262198

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: RVC, CS, PS, GR. The following authors gave final approval of the manuscript: CS, GR. Only for translation of single words (ChatGPT) was used.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.