GAS gangrene has been recognized for many years as a possible complication in war wounds, in badly contaminated wounds in civilian life, and possibly in grossly infected cases involving intra-abdominal surgery when fecal soilage has occurred. In such instances, the alert surgeon will always consider gas gangrene as a possibility and will be prepared to treat it when the first signs develop. However, when the case is one of an elective abdominal operation, in which everything appeared to go as planned, no contamination was apparent, and the early convalescence was quite routine, the development of gas gangrene will come as a shock to the totally unprepared surgeon.
In the early stage of this disease the correct diagnosis is often difficult to establish because many other possible complications appear to be more logical to the surgeon than does gas gangrene. The obvious classic sign (presence of gas infiltrating the subcutaneous tissue)
ALDRETE JS, JUDD ES. Gas GangreneA Complication of Elective Abdominal Surgery. Arch Surg. 1965;90(5):745-755. doi:10.1001/archsurg.1965.01320110081014