title: Necrotizing fasciitis caused by perforated appendicitis: a case report.
abstract: Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Hua
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China.
authors.forename: Le
authors.initials: L
authors.lastname: Yao
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: He
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China.
authors.forename: Zhen-Shun
authors.initials: ZS
authors.lastname: Song
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003646:Debridement; D057210:Delayed Diagnosis; D004630:Emergencies; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology; D011237:Predictive Value of Tests; D018805:Sepsis / Q000382:microbiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Necrotizing fasciitis; acute appendicitis; lumbar triangles; perforation