title: Necrotizing soft tissue infection of the right anterolateral abdominal wall caused by a ruptured gangrenous appendix in an elderly diabetic patient.
abstract: Necrotizing soft tissue infections (NSTIs) of the abdominal wall usually occur when either a common superficial soft tissue infection progresses down to, or an injury (e.g. knife stab) penetrates, the investing muscle fascia, or an intra-abdominal infection spreads directly to the muscle layers of the abdominal wall. These infections are severe and associated with significant morbidity and mortality. We present an 83-year-old female diabetic patient who was admitted to the surgical emergency department complaining of right abdominal pain after a fall to the floor. She had previously received oral antibiotics for a minor superficial skin infection attributed to her subcutaneous use of insulin. On admission she exhibited signs of agitation and dyspnoea with hypotension and tachycardia (systolic arterial pressure 90mmHg, heart rate >110 bpm, oxygen saturation 88%). Furthermore, she had a tender right abdomen but without any demonstrable pathology on her skin or crepitus. Arterial blood gases revealed metabolic acidosis and hypoxaemia. An abdominal computed tomography (CT) scan demonstrated signs of infection of the entire right anterior abdominal wall and the LRINEC score was calculated to be 13. Subsequent operative aggressive necrosectomy of all the involved layers of the right anterolateral abdominal wall sparing the peritoneum was undertaken. Unfortunately, the patient died the next day due to multiple organ failure.
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Marinis
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Mavroudis
authors.initials: M
authors.lastname: Voultsos
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Foteinos
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Tselioti
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Avraamidou
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Paschalidis
authors.affiliation: First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece.
authors.forename: Spyros
authors.initials: S
authors.lastname: Rizos
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000369:Aged, 80 and over; D000375:Aging; D001064:Appendicitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology; D012422:Rupture, Spontaneous; D018461:Soft Tissue Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*