NECROTIC FASCIITIS AS A COMPLICATION OF ACUTE DESTRUCTIVE APPENDICITIS

The timely diagnosis of necrotic fasciitis (NF) - an extremely rare fatal complication of acute appendicitis is difficult due to the variability of the clinical picture and depends on the degree of inflammatory changes in the appendix wall, localization, age, reactivity, and the presence or absence of comorbidities. It is characterized by high mortality rate, associated with the rapid progression of the disease with the development of septic shock and multiple organ failure. A clinical case of necrotic fasciitis of the right lower limb without damage of the anterior abdominal wall, secondary to the perforated process, as an extremely rare complication of appendicitis is presented. A 78-year-old patient was urgently operated on laparoscopically for acute gangrenous appendicitis. Necrotic fasciitis has not been diagnosed. Ten hours after the operation, the diagnosis of NF was established and the patient underwent phlegmon autopsy of the right thigh and lower leg, revision of the retroperitoneal space on the right. Subsequently, sanitation and surgical treatment of purulent foci were performed. Despite the ongoing comprehensive treatment in the intensive care unit using broad-spectrum antibiotics the disease progressed, and wet gangrene of the right lower limb developed. The patient underwent amputation at the level of the upper third of the right thigh. The course of the disease was complicated by sepsis, septic shock, bilateral pneumonia, multiple organ failure syndrome, cerebral edema. The patient died on the 8th day from the moment of hospitalization. The rarity of this formidable and fatal disease determines the difficulties of early diagnosis and timely treatment, since most doctors can see one case of NSTIs throughout their medical career. Our case shows how important the early diagnosis of this fatal complication is, as it is crucial for achieving optimal treatment results.