Abstract
Gas in the leg is not always a gas gangrene. Abdominal infection with gas forming organisms may spread to the thigh & leg. We report a case of critically ill patient who presented to the emergency department with features suggestive of septic arthritis of the left hip. Assessment and further intervention revealed subcutaneous emphysema of the leg secondary to an infection of a previously asymptomatic staghorn calculus. X-ray of the abdomen showed a left renal stone and gas in the soft tissue planes of the left retroperitoneal space while X-ray of the left femur showed gas in the soft tissue planes of the left hip region and whole thigh with no bony or joint abnormality. Such case has not been reported in English literature before. Physicians and surgeons should be aware of this condition that could be fatal but curable by early intervention.
Highlights
Gas in the leg often prompts the physician to the diagnosis of gas gangrene
We report a case of critically ill patient who presented to the emergency department with features suggestive of septic arthritis of the left hip
We describe a new cause and mechanism of subcutaneous emphysema where the gas originated from renal infection complicating a silent kidney stone in a non diabetic patient
Summary
Gas in the leg often prompts the physician to the diagnosis of gas gangrene. Other sources of gas formation such as trauma, gastrointestinal perforation or nonclostridial gas-forming infection ( in diabetics) should be considered. Several cases have been reported in which the primary disease was perforation of the gastrointestinal tract, where the gas could originate directly from the perforated viscus and the majority of the reported cases caused a diagnostic dilemma. We describe a new cause and mechanism of subcutaneous emphysema where the gas originated from renal infection complicating a silent kidney stone in a non diabetic patient. This case posed significant diagnostic difficulty and presented with late and fatal complications
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