January 2001
Presented by: Dr. A. Sarabia

An 81 year old man was admitted to hospital because of pain and subcutaneous emphysema (gas) in the right upper extremity. His previous history was unremarkable except for microcytic anemia, which had been recently investigated with upper endoscopy, revealing nothing of significance.

Within 10 hours of admission, the patient had developed subcutaneous gas involving most of his right side and a visible bruise over the right arm, surrounded by large bullae. He was taken to the operating room, where debridement of the necrotic muscle tissues involving right upper arm, shoulder and chest took place. During the procedure, he developed significant hypotension, which responded to medication and intravenous saline and albumin infusion. Postoperatively, however, he remained unresponsive and hypotensive. Disseminated intravascular coagulation developed. Within 30 hours of presentation to hospital, the patient died.