Missed acute appendicitis presenting as necrotising fasciitis of the thigh

Abstract

Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a 26-year-old woman who presented with severe thigh pain and swelling associated with irritability of a few hours' duration following 2 days history of right abdominal pain. Urgent MRI and CT scan showed features of necrotising fasciitis in the thigh spreading from an inflamed appendix. Emergency surgery was performed which revealed perforated appendix with disseminated infection in the intraperitoneal and retroperitoneal spaces as well as the right thigh. The patient rapidly deteriorated with evidence of sepsis, shock and renal impairment. In spite of surgery and all supportive measures, she succumbed shortly postoperatively. Blood culture revealed Staphylococcus aureus and Streptococci, while tissue culture showed growth of Escherichia coli and proteus.

Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report

“…Additionally, it can provide information about involvement of intraabdominal organs as a source for the infection [13–15]. MRI has been shown to be the most precise imaging method to differentiate between a simple subcutaneous infection and necrotizing fasciitis [1, 3].…”

Necrotising fasciitis: a rare complication of acute appendicitis

“…1 The abdomen, groin, and extremities are the regions most commonly affected by NF. [1][2][3][4][5] Necrotising fasciitis is commonly polymicrobial, caused by virulent toxin-producing bacteria such as Group A haemolytic streptococci and Staphylococcus aureus. Other causative bacteria include Bacteroides, Clostridium, Enterobacteriaceae, Peptostreptococcus, Proteus, Pseudomonas, and Klebsiella.…”

“…However, NF should be suspected when the severity of pain or clinical status are disproportional to local findings. 5 Laboratory studies show leucocytosis with predominant neutrophilia, 1 but is unfortunately non-specific. 5 Presence of soft tissue gas in the absence of penetrating trauma suggests a diagnosis of NF, 2 although the absence of soft tissue gas does not exclude the diagnosis, as evidenced by our case.…”

“…We have found only 18 case reports of NF caused by acute appendicitis published in the English literature. [1][2][3][4][5] The affected regions included the abdominal wall (most commonly involved), perineum, and thigh. According to Taif and Alrawi, 5 there have been only three reported cases of appendicitis complicated by NF predominantly involving the lower limb.…”

“…[1][2][3][4][5] The affected regions included the abdominal wall (most commonly involved), perineum, and thigh. According to Taif and Alrawi, 5 there have been only three reported cases of appendicitis complicated by NF predominantly involving the lower limb. All cases involved the right thigh, likely from more direct infective spread along Our case represents a rare but life-threatening consequence of a common disease despite the absence of risk factors.…”