Acute Perforated Appendicitis Complicated by Necrotizing Fasciitis and Bladder Perforation

Area of Science:

• Surgical Pathology
• Emergency Medicine

Background:

• Acute appendicitis is a common surgical condition with decreasing mortality.
• Delayed treatment, however, can lead to severe, rare complications.

Observation:

• An 81-year-old female presented with abdominal pain, later diagnosed with appendicitis, periappendiceal abscess, and extensive subcutaneous emphysema.
• Exploratory laparotomy revealed a perforated bladder, necessitating repair alongside appendectomy and debridement of necrotic tissue.

Findings:

• The patient developed necrotizing fasciitis and died of septic shock due to urine spillage and ongoing soft tissue infection.
• This case illustrates a fatal outcome from acute perforated appendicitis with unusual complications.

Implications:

• Broadening differential diagnoses for peritonitis is crucial to include rare complications such as abscesses, soft tissue infections, and adjacent organ perforation.
• Prompt recognition and management of appendicitis and its potential complications are vital, especially in elderly patients.