Reviewer ’s report  
 
Title: A Case Report of Iatrogenic Gas Gangrene Post Colonoscopy Successfully Treated With  
Conservative Management - Is Surgery Always Necessary?  
 
Version: 0 Date: 21 Apr 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
RELEVANCE - Does this case report make a contribution to medical knowledge, have 
educational  value, or highlight the need for a change in clinical practice or diagnostic/prognostic 
approaches?  
Yes, this report contributes to medical knowledge  
 
CASE DESCRIPTION - Are the details of the case sufficiently well described to understand the 
patient's symptoms and course of treatment?  
Yes, the description of the case is sufficient  
 
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the diagnosis, 
interpretation, and course of treatment medically sound?  
Yes, the work described is medically sound  
 
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the importance of the 
findings and their relevance to future understanding of disease processes, diagnosis or treatment? 
Has an adequate literatu re review pertinent to the case been included?  
Yes, the case is discussed fully in the context of the literature  
 
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED version of this 
work represent a technically sound contribution?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: This report is of a very interesting case of an unusual condition, 
promptly recognized and effectively treated.  The review and discussion is comprehensive and 
well written.  
 
REQUESTED REVISIONS :  
My only suggestion would be for the authors to list this as "presumed" gas gangrene.  They were 
not able to culture any Clostridia.  Although the physiological response was consistent with 
Clostridial infection it can occur with other causes of sepsis a lso.  While they did see small gas 
bubbles at the polypectomy site, that can occur with other bacterial infections and can also 
happen as a simple mechanical consequence of endoscopic polypectomy.  I would at least 
include these possibilities in the discus sion.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
Only what I have already suggested.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wri tten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received rei mbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or  lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary fr om an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no  to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent compe ting interests are not utilized for these reviews. This reviewer has  
agreed to publication of their comments online under a Creative Commons Attribution License  
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscri pt is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: A Case Report of Iatrogenic Gas Gangrene Post Colonoscopy Successfully Treated With  
Conservative Management - Is Surgery Always Necessary?  
 
Version: 0 Date: 21 Apr 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
RELEVANCE - Does this case report make a contribution to medical knowledge, have 
educational  value, or highlight the need for a change in clinical practice or diagnostic/prognostic 
approaches?  
Yes, this report contributes to medical knowledge  
 
CASE DESCRIPTION - Are the details of the case sufficiently well described to understand the 
patient's symptoms and course of treatment?  
Yes, the description of the case is sufficient  
 
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the diagnosis, 
interpretation, and course of treatment medically sound?  
Yes, the work described is medically sound  
 
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the importance of the 
findings and their relevance to future understanding of disease processes, diagnosis or treatment? 
Has an adequate literatu re review pertinent to the case been included?  
Yes, the case is discussed fully in the context of the literature  
 
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED version of this 
work represent a technically sound contribution?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: This report is of a very interesting case of an unusual condition, 
promptly recognized and effectively treated.  The review and discussion is comprehensive and 
well written.  
 
REQUESTED REVISIONS :  
My only suggestion would be for the authors to list this as "presumed" gas gangrene.  They were 
not able to culture any Clostridia.  Although the physiological response was consistent with 
Clostridial infection it can occur with other causes of sepsis a lso.  While they did see small gas 
bubbles at the polypectomy site, that can occur with other bacterial infections and can also 
happen as a simple mechanical consequence of endoscopic polypectomy.  I would at least 
include these possibilities in the discus sion.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
Only what I have already suggested.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wri tten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received rei mbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or  lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary fr om an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no  to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent compe ting interests are not utilized for these reviews. This reviewer has  
agreed to publication of their comments online under a Creative Commons Attribution License  
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscri pt is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: A Case Report of Iatrogenic Gas Gangrene Post Colonoscopy Successfully Treated With  
Conservative Management - Is Surgery Always Necessary?  
 
Version: 0 Date: 21 Apr 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
RELEVANCE - Does this case report make a contribution to medical knowledge, have 
educational  value, or highlight the need for a change in clinical practice or diagnostic/prognostic 
approaches?  
Yes, this report contributes to medical knowledge  
 
CASE DESCRIPTION - Are the details of the case sufficiently well described to understand the 
patient's symptoms and course of treatment?  
Yes, the description of the case is sufficient  
 
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the diagnosis, 
interpretation, and course of treatment medically sound?  
Yes, the work described is medically sound  
 
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the importance of the 
findings and their relevance to future understanding of disease processes, diagnosis or treatment? 
Has an adequate literatu re review pertinent to the case been included?  
Yes, the case is discussed fully in the context of the literature  
 
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED version of this 
work represent a technically sound contribution?  
Probably - with minor revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: This report is of a very interesting case of an unusual condition, 
promptly recognized and effectively treated.  The review and discussion is comprehensive and 
well written.  
 
REQUESTED REVISIONS :  
My only suggestion would be for the authors to list this as "presumed" gas gangrene.  They were 
not able to culture any Clostridia.  Although the physiological response was consistent with 
Clostridial infection it can occur with other causes of sepsis a lso.  While they did see small gas 
bubbles at the polypectomy site, that can occur with other bacterial infections and can also 
happen as a simple mechanical consequence of endoscopic polypectomy.  I would at least 
include these possibilities in the discus sion.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
Only what I have already suggested.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wri tten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received rei mbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or  lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary fr om an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no  to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent compe ting interests are not utilized for these reviews. This reviewer has  
agreed to publication of their comments online under a Creative Commons Attribution License  
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscri pt is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant