Researchers from Japan reported the case of a woman age 72 who underwent left hepatic trisectionectomy to treat her perihilar cholangiocarcinoma (pCCA) who died due to a liver abscess caused by Clostridium perfringens following the operation.

This case shows that C. perfringens should be considered the most likely bacterium in patients who have undergone highly invasive hepatobiliary-pancreatic surgery and show hemolysis and hepatic abscesses with gas.

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The case study is published in the journal Surgical Case Reports.

Following surgery, the patient had an uneventful course apart from bile leakage and she was discharged from the hospital on Day 35. However, 19 days later she was readmitted due to abdominal pain and high fever. 

Laboratory tests revealed a severe inflammatory reaction and hemolysis with disseminated intravascular coagulation.

She underwent abdominal contrast-enhanced computed tomography (CT), which revealed a 70-mm irregular shape and low-density containing air in her liver, suggesting a liver abscess. This was drained of pus, which contained air and many Gram-positive bacteria. 

She was treated with vancomycin and meropenem because C. perfringens had been present in the preoperative bile culture. 

However, her condition deteriorated rapidly with thrombocytopenia, hypoglycemia, tachypnea, progressive acidosis, anemia, reduced oxygen saturation, and she died 6 hours after being admitted to hospital. 

An autopsy showed that the liver abscess consisted of liver cell coagulation necrosis with inflammatory cell infiltration. The necrotic debris contained clusters of Gram-positive large bacteria. C. perfringens was present in the blood culture and drainage fluid. 

“She was diagnosed with a liver abscess and severe sepsis caused by C. perfringens and treated promptly, but the disease progressed rapidly and led to her death,” the authors said. “When patients who have undergone highly invasive hepatobiliary-pancreatic surgery show hemolysis and hepatic abscesses with gas, C. perfringens should be considered the most likely bacterium.”


Tohmatsu Y, Yamada M, Otsuka S, et al. Liver abscess caused by Clostridium perfringens after left hepatic trisectionectomy for perihilar cholangiocarcinoma: a case report. Surg Case Rep. Published online June 19, 2023. doi:10.1186/s40792-023-01687-8