Oh John
Emergency Department, Kent Hospital, Warwick, USA.
Cureus. 2021 Jan 18;13(1):e12764. doi: 10.7759/cureus.12764.
Acute uncomplicated appendicitis is a common surgical disease that has been well-studied, and its overall mortality has decreased over time. However, delay in treatment can be associated with rare complications such as necrotizing fasciitis, which carries a high mortality rate, and bladder perforation. We present such a case in an 81-year-old female with no significant surgical history who presented to the emergency department with four days of abdominal pain. A CT scan revealed extensive subcutaneous air in the abdominal wall, an inflamed appendix, and a periappendiceal abscess. During subsequent exploratory laparotomy, she was also found to have bladder perforation. She underwent debridement of necrotic tissue of the abdominal wall, appendectomy, drainage of periappendiceal abscess, and bladder perforation repair. She died of septic shock on post-operative day 19, due to gross spillage of urine into the abdomen and ongoing necrotizing fasciitis. Acute perforated appendicitis can lead to rare and fatal complications. Our case presents such a patient with a poor outcome. In approaching a patient with signs of peritonitis, differential diagnoses must remain broad to include late complications such as abscess formation, soft tissue infection, and perforation of surrounding structures.
急性单纯性阑尾炎是一种常见的外科疾病，已得到充分研究，其总体死亡率随时间推移有所下降。然而，治疗延迟可能与坏死性筋膜炎等罕见并发症相关，坏死性筋膜炎死亡率很高，还可能导致膀胱穿孔。我们报告一例81岁女性患者，既往无重大手术史，因腹痛4天就诊于急诊科。CT扫描显示腹壁广泛皮下气肿、阑尾发炎及阑尾周围脓肿。在随后的剖腹探查术中，还发现她有膀胱穿孔。她接受了腹壁坏死组织清创术、阑尾切除术、阑尾周围脓肿引流术及膀胱穿孔修补术。术后第19天，她死于感染性休克，原因是尿液大量渗入腹腔及坏死性筋膜炎持续存在。急性穿孔性阑尾炎可导致罕见且致命的并发症。我们的病例展示了这样一位预后不良的患者。在处理有腹膜炎体征的患者时，鉴别诊断范围必须广泛，要包括脓肿形成、软组织感染及周围结构穿孔等晚期并发症。
