Iqbal Rana Sikandar, Gohar Ali, Azhar Rida, Tahir Seemal, Afzal Usama, Ayyan Ahmed, Ali Masab, Ahmad Muhammad Husnain
Lahore General Hospital, Lahore, Punjab, Pakistan.
Punjab Institute of Neurosciences, Lahore, Pakistan.
Ann Med Surg (Lond). 2025 Jan 7;87(2):994-997. doi: 10.1097/MS9.0000000000002891. eCollection 2025 Feb.
Acute appendicitis is a common emergency, but its variable presentation can delay diagnosis and treatment, leading to severe complications. Necrotizing fasciitis, although rare, can arise as a life-threatening consequence of perforated appendicitis. Prompt recognition and intervention are crucial to prevent fatal outcomes.
A 23-year-old male presented with right iliac fossa pain and vomiting. Physical examination revealed tenderness and rebound tenderness in the right iliac fossa, with an Alvarado score of 7/10 and leukocytosis, suggestive of acute appendicitis. Emergency laparotomy revealed a perforated appendix with purulent fluid, which was drained, and abdomen was irrigated. Postoperatively, the patient initially stabilized but deteriorated on the second postoperative day. A CT scan revealed multiple abscesses and necrotizing fasciitis of the abdominal wall. Re-exploration with abscess drainage and debridement was performed, but the patient developed septic shock and multiple organ failure, leading to his death.
This case underscores the potential for severe complications like necrotizing fasciitis following perforated appendicitis, even in previously healthy individuals. Delays in diagnosis and imaging, as well as reliance solely on clinical judgment, can contribute to adverse outcomes. Early recognition of necrotizing fasciitis and aggressive management, including broad-spectrum antibiotics and surgical debridement, are essential to improve survival in such cases.
Delayed diagnosis and management of acute appendicitis can result in rare but fatal complications such as necrotizing fasciitis. This case emphasizes the importance of timely intervention, imaging, and a high index of suspicion to mitigate mortality in these uncommon but severe presentations.
急性阑尾炎是一种常见的急症，但其表现多样，可能会延误诊断和治疗，导致严重并发症。坏死性筋膜炎虽然罕见，但可能是穿孔性阑尾炎的危及生命的后果。及时识别和干预对于预防致命后果至关重要。
一名23岁男性出现右下腹疼痛和呕吐。体格检查发现右下腹压痛和反跳痛，阿尔瓦拉多评分7/10，白细胞增多，提示急性阑尾炎。急诊剖腹探查发现阑尾穿孔并有脓性液体，进行了引流，并对腹腔进行了冲洗。术后，患者最初病情稳定，但在术后第二天恶化。CT扫描显示腹壁有多个脓肿和坏死性筋膜炎。进行了再次探查、脓肿引流和清创，但患者出现感染性休克和多器官功能衰竭，最终死亡。
该病例强调了即使在先前健康的个体中，穿孔性阑尾炎后也可能出现坏死性筋膜炎等严重并发症。诊断和影像学检查的延迟，以及单纯依赖临床判断，都可能导致不良后果。早期识别坏死性筋膜炎并积极治疗，包括使用广谱抗生素和手术清创，对于改善此类病例的生存率至关重要。
急性阑尾炎的诊断和治疗延迟可能导致坏死性筋膜炎等罕见但致命的并发症。该病例强调了及时干预、影像学检查以及高度怀疑指数对于降低这些罕见但严重表现的死亡率的重要性。
