title: A case report of necrotizing fasciitis of the abdominal wall: A rare, life-threatening complication of a common disease process.
abstract: BACKGROUND
  Acute appendicitis is one of the most common surgical diseases, but perforated appendicitis resulting in necrotizing fasciitis of the abdominal wall is exceedingly rare.
  
  
  METHODS
  A 71-year-old male presented to the emergency department with one week of severe right-sided abdominal pain. 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, and lactic acidosis. CT scan 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.
  
  
  CONCLUSIONS
  The diagnosis of perforated appendicitis resulting in necrotizing fasciitis is often delayed due to the unusual presentation of this common disease. Necrotizing fasciitis is associated with significant mortality and requires immediate intervention.
  
  
  CONCLUSIONS
  It is imperative to maintain a high index of suspicion for intra-abdominal pathology in patients who present with necrotizing infections of the abdominal wall, flank, back, or groin. The importance of recognizing this complication early and proceeding immediately to the operating room cannot be overstated.
authors: Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of General Surgery, James J. Peters V.A. Medical Center, Bronx, NY, United States. Electronic address: anya.romanoff@mountsinai.org.
authors: Anya
authors: A
authors: Romanoff
authors: Department of General Surgery, James J. Peters V.A. Medical Center, Bronx, NY, United States.
authors: Jeffrey
authors: J
authors: Freed
authors: Department of General Surgery, James J. Peters V.A. Medical Center, Bronx, NY, United States.
authors: Tomas
authors: T
authors: Heimann
keywords: Case report; Necrotizing fasciitis; Perforated appendicitis