Sudden Onset of Lower Abdominal Pain Without Peritonitis or Ileus

A patient presented with sudden, unexplained lower abdominal pain without peritonism or signs of infection or inflammatory reaction, but with recent bloody stools and a history of radiation therapy, diabetes and immunosuppression. Plain abdominal x-ray showed only air-fluid levels and air distention of the colon, but a later abdominal CT scan revealed extensive gas gangrene of the colon. The patient’s clinical status rapidly worsened. Elective surgical rectosigmoid debridement did not prevent the patient’s death. In conclusion, the diagnosis of ‘spontaneous’ life-threatening gas gangrene requires a high degree of clinical suspicion and allows life-saving surgical intervention. LEARNING POINTS: Sudden and rapidly worsening lower abdominal pain without peritonitis or ileus can indicate gas gangrene from distal bowel perforation. Bloody stools or other symptoms and/or procedures reported previously and apparently resolved could indicate hidden perforation. Diagnostic gas detection, clinically or radiologically, occurs too late to prevent fatal consequences, so early signs of infection and inflammation should be sought for and evaluated as early surgery is life saving.