title: Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report.
abstract: BACKGROUND
  We report a case of a rare complication of acute appendicitis with perforation through the abdominal wall. The case points out that an intraabdominal origin should be considered in patients presenting with rapidly spreading soft tissue infections of the trunk.
  
  
  METHODS
  A 58-year-old European woman presented to our hospital with a 1-week history of severe abdominal pain accompanied by rapidly spreading erythema and emphysema of the lower abdomen. On admission, the patient was in septic shock with leukocytosis and elevation of C-reactive protein. Among other diagnoses, necrotizing fasciitis was suspected. Computed tomography showed a large soft tissue infection with air-fluid levels spreading through the lower abdominal wall. During the operation, we found a perforated appendicitis breaking through the fascia and causing a rapidly progressive soft tissue infection of the abdominal wall. Appendicitis was the origin of the soft tissue infection. The abdominal wall was only secondarily involved.
  
  
  CONCLUSIONS
  Even though perforated appendicitis as an etiology of a rapidly progressive soft tissue infection of the abdominal wall is very rare, it should be considered in the differential diagnosis of abdominal wall cellulitis. The distinction between rapidly spreading subcutaneous infection with abscess formation and early onset of necrotizing fasciitis is often difficult and can be confirmed only by surgical intervention.
authors.affiliation: Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland. corinne.beerle@bluewin.ch.
authors.forename: Corinne
authors.initials: C
authors.lastname: Beerle
authors.affiliation: Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Gelpke
authors.affiliation: Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Breitenstein
authors.affiliation: Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
authors.forename: Ralph F
authors.initials: RF
authors.lastname: Staerkle
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000473:pathology; D034861:Abdominal Wall / Q000382:microbiology / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D004646:Emphysema / Q000000981:diagnostic imaging / Q000473:pathology; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010538:Peritonitis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D012086:Reoperation; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: Abscess of the abdominal wall; Case report; Perforated appendicitis; Soft tissue infection