Complicated acute appendicitis presenting as a necrotizing fasciitis of the abdominal wall: a case report

Abstract

Acute appendicitis is one of the most common surgical diseases, but necrotizing fasciitis of the abdominal wall because of perforation is extremely rare. A 50-year-old male presented to the emergency department with severe right-sided abdominal pain for a week. He was hypothermic, hypotensive, and tachycardic. His abdomen was distended, with a large, tender, erythematous region over the right abdominal wall. Laboratory evaluation revealed leukocytosis, acute kidney injury. Computed tomography revealed large collections of fluid and gas in the right abdominal wall as well as inflammation surrounding the right colon. The patient was resuscitated with intra-venous fluid, started on broad-spectrum antibiotics, and emergently brought to the operating room. The patient underwent an exploratory laparotomy, and was found to have appendicitis, which perforated into his abdominal wall resulting in a necrotizing soft tissue infection. It is important to recognize this complication early and proceed immediately to the operating room.

Keywords

• Perforated appendicitis,abdominal wall abscess,necrotizing fasciitis

References

1. [1] Giuliano A, Lewis F Jr, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg 1977;134:52-7.
2. [2] Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996;224:672-83.
3. [3] Chen CW, Hsiao CW, Wu CC, Jao SW, Lee TY, Kang JC. Necrotizing fasciitis due to acute perforated appendicitis: case report. J Emerg Med 2010;39:178-80.
4. [4] Ishigami K, Khanna G, Samuel I, Dahmoush L, Sato Y. Gas-forming abdominal wall abscess: unusual manifestation of perforated retroperitoneal appendicitis extending through the superior lumbar triangle. Emerg Radiol 2004;10:207-9.
5. [5] Hua J, Yao L, He Z-G, Xu B, Song Z-S. Necrotizing fasciitis caused by perforated appendicitis: a case report. Int J Clin Exp Pathol 2015;8:3334-8.
6. [6] Gujral S, Hughes JM, Wiberg A. Necrotizing fasciitis. Eplasty 2014;14:ic15.
7. [7] McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221:558-65.
8. [8] Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-41.

9. [9] Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol 1998;170:615-20.