case_images: PMC9546719_01
case_images: (a) Endoscopy at diagnosis showed a type 2 tumor in the hepatic curvature of the ascending colon. (b)-(c) Autopsy imaging shows gas retention in the tumor and metastasis of the liver and portal vein. There was also free air in the abdominal cavity, suggesting perforation of the gastrointestinal tract. (d) In the pathological autopsy, the foul-smelling gas was removed upon opening the abdomen, and the tumor area in the colon was perforated. (e) Numerous Gram-positive bacilli were found in the perforation of the colon tumor. (f) Numerous Gram-positive rods were found in the liver with gas production. (g) In the kidney, the fungus destroyed the glomerular appendages. (h) Gram staining of the blood confirmed Gram-positive rods.
case_images: CRIID2022-1071582.001.jpg
case_images: PMC9546719_01_CRIID2022-1071582.001.jpg
case_images: fig1
case_images: Colonoscopy revealed a 3-cm-diameter type 2 colorectal cancer in the liver curvature of the transverse colon (Figure1(a)). At the time of laparotomy, gas with a strange odor was removed, and there was perforation in the tumor part of the hepatic curve (Figure 1(d)). Pathological findings showed numerous Gram-positive rods in the perforated part of the tumor (Figure 1(e)). A large number of Gram-positive rods with gas production were also found in the liver (Figure 1(f)). In the kidney, the bacteria destroyed the glomerular capillaries (Figure 1(g)). Gram staining of the blood also showed Gram-positive rods (Figure 1(h)), and blood culture was positive for C. perfringens.
case_images: Contrast-enhanced CT on admission shows rapid progression of the primary tumor and liver metastases compared with that in the initial examination 1 month prior.
case_images: CRIID2022-1071582.002.jpg
case_images: PMC9546719_01_CRIID2022-1071582.002.jpg
case_images: fig2
case_images: CEA 1.2 ng/ml and CA19-9 15 U/ml (Table 1). Contrast-enhanced CT scan showed rapid progression of the primary tumor and liver metastases compared to the initial visit one month before (Figure 2), and we considered that the fever and changes in the blood data were due to the rapid deterioration of the liver metastases.