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Amer et al. J Cancer Metastasis Treat 2016;2:402-6 Journal of
DOI: 10.20517/2394-4722.2016.16
Cancer Metastasis and Treatment

www.jcmtjournal.com
Case Report Open Access

Metastatic clostridial myonecrosis

secondary to perforated metastatic bowel

cancer

Nasser Mohammed Amer , John Karayanis 2
1
1 King Fahad Hospital of the University, Al Khobar 31952, Saudi Arabia.
2 Locum Consultant General Surgery, Hereford County Hospital, Hereford HR1 2ER, United Kingdom.
Correspondence to: Dr. Nasser Mohammed Amer, King Fahad Hospital of the University, P O Box 40262, Al Khobar 31952, Saudi Arabia.
E-mail: nasser@nasseramer.com
How to cite this article: Amer NM, Karayanis J. Metastatic clostridial myonecrosis secondary to perforated metastatic bowel cancer. J Cancer
Metastasis Treat 2016;2:402-6.

ABSTRACT
Article history: Spontaneous metastatic clostridial myonecrosis is a rare condition caused by Clostridium
Received: 05-04-2016 septicum. The underlying lesion is usually either a colonic neoplasm or leukemia. The
Accepted: 06-07-2016 authors reported a 67-year-old female who presented with acute abdomen secondary to a
Published: 21-10-2016 perforated sigmoid cancer and who developed gas gangrene in her right leg. Unfortunately,
despite all resuscitative measures, she died. The authors reviewed the literature; the
Key words: diagnosis of metastatic myonecrosis was based on a high index of suspicion, development
Metastatic gangrene, of bullae containing gram-positive rods, and subcutaneous crepitus (although this was
perforated sigmoid cancer, a late sign). Treatment involves aggressive fluid replacement, high doses of intravenous
myonecrosis, penicillin, high concentration of oxygen, and surgical debridement, and/or amputation.
clostridia The mortality remains very high, despite all the above measures.

INTRODUCTION of early aggressive management. We reported a
case of a 67-year-old woman who developed sudden
Metastatic clostridial myonecrosis is an uncommon myonecrosis in her right thigh secondary to perforated
complication of malignancy, particularly of the large bowel cancer.
gastrointestinal tract, and of leukemia. Without
treatment the mortality rate reaches 100% within CASE REPORT
48 h. [1-4] A number of reports have demonstrated the
association between atraumatic clostridial infection
and internal malignancy. [5] A 67-year-old female was admitted to a district general
hospital via a general practitioner referral, complaining
We reviewed the literature, which demonstrated the mainly of pain in the epigastrium for the past four days.
paramount importance of early diagnosis and institution Pain became worse and more constant on the day of

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