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Necrotizing fasciitis of chest and right abdominal wall caused by acute perforated appendicitis: Case report

Lotfi Rebai1, Aziz Daghmouri1, Ines Boussaidi1

  • 1Department of Anesthesiology and Critical Care Medicine, Burns and Trauma Center, Ben Arous, Tunisia.

International Journal of Surgery Case Reports
|October 28, 2018
PubMed
Abstract

Insights

Necrotizing fasciitis of the chest wall is a rare complication of acute appendicitis. This case highlights the importance of prompt diagnosis and aggressive treatment, including antibiotics and surgical debridement, for this life-threatening condition.

Area of Science:

  • Infectious Diseases
  • Surgical Pathology

Background:

  • Necrotizing fasciitis is a severe, rapidly progressing soft tissue infection.
  • Concurrent necrotizing fasciitis of the chest wall and acute appendicitis is exceptionally rare.
  • Prompt recognition and intervention are critical for patient outcomes.

Purpose of the Study:

  • To report an extremely unusual case of necrotizing fasciitis of the chest wall secondary to acute appendicitis.
  • To emphasize the diagnostic and therapeutic challenges associated with this rare clinical presentation.

Main Methods:

  • A case report of a 27-year-old male patient presenting with septic shock post-appendectomy.
  • Clinical presentation included abdominal wall erythema, progressing to chest wall necrosis and pleural effusion.
  • Management involved intensive care, broad-spectrum antibiotics, surgical debridement, and wound management.

Main Results:

  • The patient developed extensive necrotizing fasciitis involving the abdominal wall, retroperitoneum, and chest wall.
  • Computed tomography revealed pleural effusion and rib erosion.
  • Superinfection with Acinetobacter Baumannii necessitated antibiotic modification.

Conclusions:

  • Acute appendicitis can lead to severe, life-threatening necrotizing fasciitis extending to the chest wall.
  • Optimal treatment requires a multimodal approach: appropriate antibiotics, adequate oxygenation, and aggressive surgical debridement.
  • Early diagnosis and management are paramount to reduce morbidity and mortality.
Keywords:
Acute appendicitisCase reportChestNecrotizing fasciitisPerforation

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