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 wallbecause of perforation is extremely rare. A 50-year-old male presented to the emergency department with severeright-sided abdominal pain for a week. He was hypothermic, hypotensive, and tachycardic. His abdomen wasdistended, with a large, tender, erythematous region over the right abdominal wall. Laboratory evaluationrevealed leukocytosis, acute kidney injury. Computed tomography revealed large collections of fluid and gasin the right abdominal wall as well as inflammation surrounding the right colon. The patient was resuscitatedwith 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 intohis abdominal wall resulting in a necrotizing soft tissue infection. It is important to recognize this complicationearly and proceed immediately to the operating room.