Point-of-care ultrasound in the diagnosis of hepatic gas gangrene.

Abstract

Hepatic gas gangrene (HGG) is a rare but life-threatening condition typically caused by anaerobic bacteria such as Clostridium perfringens, though Gram-negative bacteria like Escherichia coli and Klebsiella species have also been implicated. Traditionally diagnosed via computed tomography (CT), point-of-care ultrasound (POCUS) has emerged as a valuable tool in critical care settings for its non-invasive, bedside utility. We report the case of a 51-year-old female with choledochal syndrome secondary to cholangiocarcinoma who developed HGG following left extended hepatectomy and biliary reconstruction. POCUS revealed free subhepatic fluid, hypoechogenicity in the right hepatic lobe, and comet-tail artifacts suggestive of intrahepatic gas, leading to prompt surgical intervention. Despite maximal supportive measures, the patient succumbed to refractory shock. This case underscores the utility of POCUS in the rapid diagnosis and management of HGG, offering a non-invasive alternative to traditional imaging, and highlights its potential as a primary diagnostic tool for HGG in critically ill patients.