Retroperitoneal necrotising fasciitis - perils of obesity and acute appendicitis

Obesity complicates clinical evaluations of acute abdominal conditions like appendicitis, with excess fat limiting the accuracy of physical examinations and delaying diagnosis. This report presents a case of a 49-year-old morbidly obese female with uncontrolled diabetes who developed acute peritonitis secondary to retrocaecal appendicitis, which presented as retroperitoneal necrotising fasciitis (NF). Diagnostic delays were attributed to atypical clinical signs and limitations of ultrasound in obese patients. A computed tomography (CT) scan eventually revealed extensive retroperitoneal fluid collections, confirming the diagnosis. Surgical intervention, including appendicectomy, drainage, and debridement, was complicated by septic shock, requiring intensive care. This case highlights the diagnostic complexity of NF in high-risk patients, emphasising the role of advanced imaging modalities and diagnostic scoring systems. Improved diagnostic strategies and early imaging are crucial for managing life-threatening conditions in obese populations.