Necrotising fasciitis: a rare complication of acute appendicitis

Chin, Takaaki; Ko, Kyungmin; Tsang, K

doi:10.12809/hkmj166180

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…However, it can lead to perforation and subsequent complications such as periappendiceal abscess or peritonitis, especially if disease recognition and management are delayed. In the case of perforation, the mortality increases nearly six-fold [2]. Complications that follow perforation are rare.…”

Section: Introductionmentioning

confidence: 99%

Acute Perforated Appendicitis Complicated by Necrotizing Fasciitis and Bladder Perforation

Oh¹

2021

Cureus

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Acute uncomplicated appendicitis is a common surgical disease that has been well-studied, and its overall mortality has decreased over time. However, delay in treatment can be associated with rare complications such as necrotizing fasciitis, which carries a high mortality rate, and bladder perforation. We present such a case in an 81-year-old female with no significant surgical history who presented to the emergency department with four days of abdominal pain. A CT scan revealed extensive subcutaneous air in the abdominal wall, an inflamed appendix, and a periappendiceal abscess. During subsequent exploratory laparotomy, she was also found to have bladder perforation. She underwent debridement of necrotic tissue of the abdominal wall, appendectomy, drainage of periappendiceal abscess, and bladder perforation repair. She died of septic shock on post-operative day 19, due to gross spillage of urine into the abdomen and ongoing necrotizing fasciitis. Acute perforated appendicitis can lead to rare and fatal complications. Our case presents such a patient with a poor outcome. In approaching a patient with signs of peritonitis, differential diagnoses must remain broad to include late complications such as abscess formation, soft tissue infection, and perforation of surrounding structures.

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Section: Introductionmentioning

confidence: 99%

Acute Perforated Appendicitis Complicated by Necrotizing Fasciitis and Bladder Perforation

Oh¹

2021

Cureus

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“…Necrotizing fasciitis is a rare but life-threatening complication of appendicitis caused by rapidly spreading necrotizing infection of the skin, subcutaneous tissues, and fascia, which might progress to sepsis, multiorgan failure, and death. Muscles are often spared [10]. Necrotizing fasciitis was first described by US Confederate Army Surgeon Joseph Jones, who described it as "hospital gangrene" [11].…”

Section: Discussionmentioning

confidence: 99%

A Rare Complication of Perforated Appendicitis: A Case of Necrotizing Fasciitis

Suleimanov¹,

Alhanabi²,

Saeed³

et al. 2022

Cureus

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Acute appendicitis is considered one of the most common surgical emergencies with low morbidity and mortality. However, delay in the diagnosis may lead to perforation of the appendix. Hence, complications may arise, including necrotizing fasciitis, a rare complication of a perforated appendix. We present a case of perforated appendicitis complicated by necrotizing fasciitis leading to rapid deterioration.A 75-year-old male patient presented to our emergency room with a three-day history of right lower quadrant abdominal pain and abdominal distention. On admission, computed tomography (CT) scan showed a perforated appendix and peri-appendicular abscess. An exploratory laparotomy was performed. The appendix was resected and the wound closed. The patient was recovering well and tolerating food after the procedure. However, the patient developed progressive erythema/swelling over the right flank with newonset leukocytosis. The diagnosis of necrotizing fasciitis was suspected and confirmed by careful evaluation and laboratory/radiological tests. Antibiotics were changed to clindamycin and piperacillin/tazobactam, and the patient was taken back to the operation room (OR) for surgical debridement. Postoperatively, the patient was shifted to the intensive care unit (ICU). He developed hearing impairment, which improved after the cessation of clindamycin. He was discharged in good condition after three weeks of hospital stay. This case report highlights the importance of maintaining a high index of suspicion for necrotizing soft tissue infection in immunocompromised patients with perforated appendicitis and being cautious when prescribing clindamycin to patients at risk of hearing loss.

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“…The incidence of necrotizing fasciitis has risen recently associated with an increased prevalence of patients with comorbidities [7] . Mortality remains high owing to its fulminant progression [3] . The involvement of the abdominal wall is usually the result of minor skin trauma or infection, or secondary to postoperative complications [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Severe complications may occur if diagnosis and management are delayed. However, necrotizing fasciitis is a very uncommon issue in patients with appendicitis [3] , [4] . A case of necrotizing fasciitis in the lumbar region secondary to appendicitis is presented.…”

Section: Introductionmentioning

confidence: 99%

Necrotising fasciitis: a rare complication of acute appendicitis

Cited by 5 publications

References 4 publications

Acute Perforated Appendicitis Complicated by Necrotizing Fasciitis and Bladder Perforation

Acute Perforated Appendicitis Complicated by Necrotizing Fasciitis and Bladder Perforation

A Rare Complication of Perforated Appendicitis: A Case of Necrotizing Fasciitis

Necrotizing fasciitis of the back originating from a perforated appendicitis: A case report

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