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Falconi S, Wilhelm C, Loewen J, Soliman B. Necrotizing Fasciitis of the Abdominal Wall Secondary to Complicated Appendicitis: A Case Report. Cureus 2023; 15:e39635. [PMID: 37388614 PMCID: PMC10305508 DOI: 10.7759/cureus.39635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Acute appendicitis is one of the most common surgical emergencies worldwide. Many complications can occur secondary to complicated appendicitis including abscess formation, gangrene, sepsis, and perforation, rarely, leading to abdominal wall necrotizing fasciitis. The incidence of necrotizing fasciitis as a complication of ruptured appendicitis is extremely uncommon. The formation of an enterocutaneous fistula leading to this complication further emphasizes the rarity of such occurrence with few cases reported in the literature. Herein, we present a case of abdominal wall necrotizing fasciitis in a 72-year-old female presenting to the local emergency room with complaints of severe suprapubic abdominal pain associated with abdominal distension and acute onset foul-smelling drainage. Physical exam was significant for suprapubic and right lower quadrant abdominal tenderness with associated large indurated tender lesion and purulent weeping with large ecchymosis. Abdominal computed tomography (CT) revealed extensive subcutaneous emphysema, a large cavity with layering fluid extending into the peritoneal space, and a possible fistula formation between the intra-abdominal cavity and subcutaneous tissue. Following the diagnosis of probable necrotizing fasciitis secondary to fistula formation, the patient underwent emergent exploratory laparotomy and extensive debridement of necrotic tissue. In this report, we take the opportunity to highlight the importance of promptly recognizing and treating this uncommon complication and maintaining a high level of suspicion to prevent life-threatening consequences.
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Affiliation(s)
- Sirin Falconi
- Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, USA
| | - Christopher Wilhelm
- General Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, USA
| | - Jocelin Loewen
- General Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, USA
| | - Basem Soliman
- Department of Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
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Bergeron E, Bure L. Necrotizing fasciitis of the back originating from a perforated appendicitis: A case report. Int J Surg Case Rep 2022; 99:107656. [PMID: 36181740 PMCID: PMC9568761 DOI: 10.1016/j.ijscr.2022.107656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/10/2022] [Accepted: 09/10/2022] [Indexed: 10/28/2022] Open
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Rakhsha M, Hosseinzadeh R, Hosseinzadeh D, Behnamfar M, Kazemi K. Case report of open appendectomy in treating acute perforated appendicitis with necrotizing fasciitis of the abdominal wall: A rare complication of a common disease. Clin Case Rep 2022; 10:e05354. [PMID: 35140959 PMCID: PMC8813666 DOI: 10.1002/ccr3.5354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/26/2021] [Accepted: 01/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mohsen Rakhsha
- Department of Surgery School of Medicine North Khorasan University of Medical Sciences Bojnurd Iran
| | | | | | - Morteza Behnamfar
- School of Medicine North Khorasan University of Medical Sciences Bojnurd Iran
| | - Kataneh Kazemi
- Department of Surgery School of Medicine North Khorasan University of Medical Sciences Bojnurd Iran
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McDonald SJ, Lee F, Dean N, Ridley LJ, Stewart P. Fistulae involving the appendix: a systematic review of the literature. ANZ J Surg 2021; 90:1878-1887. [PMID: 33710738 DOI: 10.1111/ans.15805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The appendix has a unique place in surgical history. Although the first ever appendicectomy involved a fistula to the skin, fistulae involving the appendix remain uncommon and can lead to unique surgical considerations. METHODS A systematic review of the literature was performed for case reports of appendiceal fistulae. We excluded cases in which the patient had a history of appendicectomy. Cases were categorized by site and aetiology, with information regarding relative frequency and demographics obtained. RESULTS A total of 301 case reports of fistula involving the appendix were found. The most common sites of these fistulae were to the bladder (148 cases), skin (40 cases), vasculature (19 cases), umbilicus (16 cases) and to the gastrointestinal tract. The most common aetiology in sub-analysis was appendicitis alone (150 cases), with less common causes including appendiceal adenocarcinoma (32 cases) and congenital abnormalities (18 cases). There were significantly more appendiceal fistulae in males than in females, with a ratio of 1.7:1. In patients with appendiceal adenocarcinoma as a cause for fistula, there were significantly more females than males with a ratio of 2.3:1. CONCLUSION In conducting a systematic review of case reports of fistulae involving the appendix, we identified 301 unique case reports, with a range of different sites and aetiologies.
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Affiliation(s)
- Stephen J McDonald
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Felix Lee
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Nicholas Dean
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Discipline of Medical Imaging, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Stewart
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Concord Hospital, Sydney, New South Wales, Australia
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Funk S, Warren K, DeNapoli TS, Mitchell IC. Necrotizing Fasciitis of the Right Lower Extremity from Ruptured Appendicitis: Case Report. JBJS Case Connect 2021; 11:e20.00250. [PMID: 33587485 DOI: 10.2106/jbjs.cc.20.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The patient is a 16-year-old girl with history of dermatomyositis in remission for several years who presented with complaints of right thigh pain and elevated inflammatory markers. She presented to the Emergency Room (ER) on separate occasions and was diagnosed with right lower extremity necrotizing fasciitis secondary to ruptured appendix. She underwent 11 surgical procedures and extended hospital stay. CONCLUSION This case is a unique presentation of ruptured appendicitis without abdominal pain that presented as right lower extremity necrotizing fasciitis and posed a diagnostic challenge. This case illustrates the importance of diligent evaluation and aggressive surgical management in musculoskeletal infections.
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Affiliation(s)
- Shawn Funk
- Section Pediatric Orthopaedic Surgery, Orthopaedic Surgery Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Kelley Warren
- Section Pediatric Orthopaedic Surgery, Orthopaedic Surgery Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Thomas S DeNapoli
- Department Pathology, Children's Hospital of San Antonio, San Antonio, Texas
| | - Ian C Mitchell
- Pediatric General Surgery, Children's Hospital of San Antonio, San Antonio, Texas
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Jiang J, Wu Y, Tang Y, Shen Z, Chen G, Huang Y, Zheng S, Zheng Y, Dong R. A novel nomogram for the differential diagnosis between advanced and early appendicitis in pediatric patients. Biomark Med 2019; 13:1157-1173. [PMID: 31559834 DOI: 10.2217/bmm-2019-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To develop a nomogram for differential diagnosis between advanced and early pediatric appendicitis (PA). Patients & methods: We retrospectively studied 669 PA patients. Patient characteristics and 24 serum markers were subjected to univariate and multivariate analysis, based on which the nomogram was constructed. Results: Fibrin degradation product, CRP and Na+ differed significantly between the advanced and early PA. The value of area under the receiver operating characteristic curve (AUC) was 0.8602, which was greater than that of a single serum marker. Furthermore, the nomogram showed better discriminative ability than the biomarker alone. Notably, validation indicated high stability and reproducibility. Conclusion: The nomogram is superior to the serum marker alone, and may hold promise in clinical application.
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Affiliation(s)
- Jingying Jiang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Ying Wu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Yue Tang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Zhen Shen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Gong Chen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Yanlei Huang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
| | - Yijie Zheng
- Department of Medical Scientific Affairs, Wuxi Diagnosis, Wuxi Apptec, Shanghai, PR China
| | - Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai 201102, PR China
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Guo K, Gong W, Zheng T, Hong Z, Wu X, Ren H, Wang G, Gu G, Nthumba P, Ren J, Li J. Clinical parameters and outcomes of necrotizing soft tissue infections secondary to gastrointestinal fistulas. BMC Infect Dis 2019; 19:597. [PMID: 31288746 PMCID: PMC6617561 DOI: 10.1186/s12879-019-4248-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/01/2019] [Indexed: 12/14/2022] Open
Abstract
Background Necrotizing soft tissue infections (NSTIs) is severe surgical infections which can occur following trauma or abdominal surgery. NSTIs secondary to gastrointestinal (GI) fistula is a rare but severe complication. Methods A retrospective cohort study was performed on all subjects presenting with GI fistulas associated NSTIs were included. Clinical characteristics, microbiological profile, operations performed, and outcomes of patients were analyzed. Results Between 2014 and 2017, 39 patients were finally enrolled. The mean age were 46.9 years and male were the dominant. For the etiology of fistula, 25 (64.1%) of the patients was due to trauma. Overall, in-hospital death occurred in 15 (38.5%) patients. Microbiologic findings were obtained from 31 patients and Klebsiella pneumoniae was the most common species (41.0%). Eight patients were treated with an open abdomen; negative pressure wound therapy was used in 33 patients and only 2 patients received hyperbaric oxygen therapy. Younger age and delayed abdominal wall reconstruction repair were more common in trauma than in non-trauma. Non-survivors had higher APACHE II score, less source control< 48 h and lower platelet count on admission than survivors. Multiple organ dysfunction syndrome, multidrug-resistant organisms and source control failure were the main cause of in-hospital mortality. Conclusions Trauma is the main cause of GI fistulas associated NSTIs. Sepsis continues to be the most important factor related to mortality. Our data may assist providing enlightenment for quality improvement in these special populations.
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Affiliation(s)
- Kun Guo
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Wenbin Gong
- Department of General Surgery, School of Medicine, Southeast University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Tao Zheng
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Zhiwu Hong
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Xiuwen Wu
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Huajian Ren
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Gefei Wang
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | - Guosheng Gu
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
| | | | - Jianan Ren
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
| | - Jieshou Li
- Department of General Surgery, Medical School of Nanjing University, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China
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Kauffman JD, O'Brien M, Snyder CW, Rottgers SA, Rideout DA, Chandler NM. Acute appendicitis complicated by necrotizing fasciitis in a teenager. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Beerle C, Gelpke H, Breitenstein S, Staerkle RF. Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report. J Med Case Rep 2016; 10:331. [PMID: 27906036 PMCID: PMC5134067 DOI: 10.1186/s13256-016-1122-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
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. Case presentation 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.
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Affiliation(s)
- Corinne Beerle
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
| | - Hans Gelpke
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ralph F Staerkle
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
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Romanoff A, Freed J, Heimann T. A case report of necrotizing fasciitis of the abdominal wall: A rare, life-threatening complication of a common disease process. Int J Surg Case Rep 2016; 28:355-356. [PMID: 27794239 PMCID: PMC5090189 DOI: 10.1016/j.ijscr.2016.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/11/2016] [Indexed: 11/24/2022] Open
Abstract
A patient presented with sepsis and a necrotizing infection of the abdominal wall. Upon operative exploration he was found to have perforated appendicitis. Maintain a high index of suspicion as diagnosis is often delayed. Necrotizing fasciitis results in significant mortality; immediate intervention is paramount.
Introduction Acute appendicitis is one of the most common surgical diseases, but perforated appendicitis resulting in necrotizing fasciitis of the abdominal wall is exceedingly rare. Presentation of case 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. Discussion 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. Conclusion 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.
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Affiliation(s)
- Anya Romanoff
- 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.
| | - Jeffrey Freed
- Department of General Surgery, James J. Peters V.A. Medical Center, Bronx, NY, United States
| | - Tomas Heimann
- Department of General Surgery, James J. Peters V.A. Medical Center, Bronx, NY, United States
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Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6508619. [PMID: 27274988 PMCID: PMC4870336 DOI: 10.1155/2016/6508619] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC) curve (AUC) was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 103/μL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+), 3.44; LR(−), 0.017. AUC values were 0.845 (95% CI 0.800–0.891) for WBC and 0.887 (95% CI 0.841–0.932) for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/μL) and CRP (≥1.17 mg/L) yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis.
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Chingkoe CM, Jahed A, Loreto MP, Sarrazin J, McGregor CT, Blaichman JI, Glanc P. Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis. Radiographics 2015; 35:1095-107. [DOI: 10.1148/rg.2015140071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hua J, Yao L, He ZG, Xu B, Song ZS. Necrotizing fasciitis caused by perforated appendicitis: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:3334-3338. [PMID: 26045863 PMCID: PMC4440172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/21/2015] [Indexed: 06/04/2023]
Abstract
Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.
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Affiliation(s)
- Jie Hua
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China
| | - Le Yao
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China
| | - Zhi-Gang He
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China
| | - Bin Xu
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China
| | - Zhen-Shun Song
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine 301 Yanchang Middle Road, Shanghai 200072, China
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Gu GL, Wang L, Wei XM, Li M, Zhang J. Necrotizing fasciitis secondary to enterocutaneous fistula: Three case reports. World J Gastroenterol 2014; 20:7988-7992. [PMID: 24976737 PMCID: PMC4069328 DOI: 10.3748/wjg.v20.i24.7988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.
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