SYMMETRICAL PERIPHERAL GANGRENE IN THE POSTPARTUM PERIOD: A RARE AND DEVASTATING COMPLICATION

Authors

  • MB YASIN Department of General Surgery, Bahawal Victoria Hospital Bahawalpur, Pakistan
  • LT QADAR Department of General Surgery, Bahawal Victoria Hospital Bahawalpur, Pakistan
  • MA RIAZ Department of General Surgery, Bahawal Victoria Hospital Bahawalpur, Pakistan
  • MH HAFEEZ Department of General Surgery, Bahawal Victoria Hospital Bahawalpur, Pakistan
  • M RAHEEL Department of General Surgery, Bahawal Victoria Hospital Bahawalpur, Pakistan
  • F ASHFAQ Department of General Surgery, Shaikh Zayed Lahore, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.96

Keywords:

Symmetrical Peripheral Gangrene, Postpartum Complications, Sepsis, DIC, Amputation

Abstract

Background: Symmetrical Peripheral Gangrene (SPG) is a rare but life-threatening condition marked by ischemic necrosis of extremities without major vessel occlusion. It is often associated with disseminated intravascular coagulation (DIC), sepsis, or vasopressor use. Case Presentation: We report a case of a 35-year-old woman who developed SPG in both feet and the right hand after a spontaneous vaginal delivery at home. She developed fever and abdominal pain one week postpartum and subsequently received intravenous antibiotics and two blood transfusions at a private facility. Shortly after the second transfusion, she developed progressive discoloration and pain in her extremities. She was eventually diagnosed with SPG and underwent a below-knee amputation. Conclusion: This case highlights the importance of early recognition and management of sepsis and coagulopathy in the postpartum period to prevent irreversible complications such as SPG.

References

Macheka K., Masamha T., Mungani H., & Kumirayi L. Symmetrical peripheral gangrene: a rare clinical entity. Clinical Case Reports 2020;8(12):2913-2916. https://doi.org/10.1002/ccr3.3300

Sil A., Chakraborty U., Chandra A., & Biswas S.. COVID-19-associated symmetrical peripheral gangrene: a case series. Diabetes & Metabolic Syndrome Clinical Research & Reviews 2022;16(1):102356. https://doi.org/10.1016/j.dsx.2021.102356

Foead A., Mathialagan A., Varadarajan R., & Larvin M.. Management of symmetrical peripheral gangrene. Indian Journal of Critical Care Medicine 2018;22(12):870-874. https://doi.org/10.4103/ijccm.ijccm_379_18

Khan M., Shahid S., Zafar A., Khan N., & Bhatty S.. Unusual initial presentation of primary antiphospholipid syndrome as postpartum symmetrical peripheral gangrene. Journal of Ayub Medical College Abbottabad 2022;34(1). https://doi.org/10.55519/jamc-01-8695

Wang Y., Tang C., Li Y., & Hu W. Puerperal septic shock complicated with symmetrical peripheral gangrene: a case report. Medicine 2024;103(13):e37571. https://doi.org/10.1097/md.0000000000037571

Priyanka S., Dasgupta D., Abdullah A., Ali N., Khatun H., & Billah S.. The gap between coverage and components of postnatal care, as well as factors associated with quality postnatal care, among home and facility births in Bangladesh. 2023. https://doi.org/10.20944/preprints202312.1122.v1

Ali H., Mahmood Q., Jalil A., & Fischer F. Women’s status and its association with home delivery: a cross-sectional study conducted in Khyber-Pakhtunkhwa, Pakistan. Maternal and Child Health Journal 2022;26(6):1283-1291. https://doi.org/10.1007/s10995-021-03294-1

Batool W., Naveed S., Khan S., & Ahmed S.. Postpartum septic shock presenting as symmetrical peripheral gangrene: a rare entity. Pakistan Journal of Medical Sciences 2023;39(3). https://doi.org/10.12669/pjms.39.3.7277

Basnet S., Rajagopalan P., Dhital R., & Qureshi A. Symmetrical peripheral gangrene associated with low output cardiac failure. Medicina 2019;55(7):383. https://doi.org/10.3390/medicina55070383

Nazir S., Nazir A., Iqbal M., Shahnawaz S., Malik S., & Ali S.. Frequency of maternal morbidity and mortality in women with primary postpartum hemorrhage. Pak-Euro Journal of Medical and Life Sciences 2021;4(4):353-358. https://doi.org/10.31580/pjmls.v4i4.2441

Hussain M., Sharma S., Synmon B., & Hynniewta Y.. Digital gangrene in spinal tuberculosis. Indian Journal of Case Reports 2020;6(8):471-473. https://doi.org/10.32677/ijcr.2020.v06.i08.017

Adamu K. and Muhammad A. Symmetrical peripheral gangrene resulting from application of henna: a rare clinical occurrence. Pyramid Journal of Medicine 2023;6(2). https://doi.org/10.4081/pjm.2023.326

Chen X., Shao G., Zhao S., & Li N.. Symmetrical peripheral gangrene after cardiac surgery: a case report and review of the literature. Medicine 2025;104(7):e41527. https://doi.org/10.1097/md.0000000000041527

Warkentin T. and Ning S.. Symmetrical peripheral gangrene in critical illness. Transfusion and Apheresis Science 2021;60(2):103094. https://doi.org/10.1016/j.transci.2021.103094

Balasundaran P., Manoharan H., Bhargava J., Arya V., & Natarajan G. A curious case of black limb in tuberculosis. Journal of Global Infectious Diseases 2023;16(1):36-38. https://doi.org/10.4103/jgid.jgid_94_23

Downloads

Published

2025-07-15

How to Cite

YASIN , M., QADAR , L., RIAZ , M., HAFEEZ , M., RAHEEL , M., & ASHFAQ , F. (2025). SYMMETRICAL PERIPHERAL GANGRENE IN THE POSTPARTUM PERIOD: A RARE AND DEVASTATING COMPLICATION. Pakistan Journal of Intensive Care Medicine, 5(02), 96. https://doi.org/10.54112/pjicm.v5i02.96

Issue

Section

Case Report