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Case Reports
. 2016 Dec 1;10(1):331.
doi: 10.1186/s13256-016-1122-1.

Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report

Corinne Beerle  1 , Hans Gelpke  2 , Stefan Breitenstein  2 , Ralph F Staerkle  2
Affiliations
Case Reports

Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report

Corinne Beerle et al. J Med Case Rep. .

Abstract

Background: We report a case of a rare complication of acute appendicitis with perforation through the abdominal wall. The case points out that an intraabdominal origin should be considered in patients presenting with rapidly spreading soft tissue infections of the trunk.

Case presentation: A 58-year-old European woman presented to our hospital with a 1-week history of severe abdominal pain accompanied by rapidly spreading erythema and emphysema of the lower abdomen. On admission, the patient was in septic shock with leukocytosis and elevation of C-reactive protein. Among other diagnoses, necrotizing fasciitis was suspected. Computed tomography showed a large soft tissue infection with air-fluid levels spreading through the lower abdominal wall. During the operation, we found a perforated appendicitis breaking through the fascia and causing a rapidly progressive soft tissue infection of the abdominal wall. Appendicitis was the origin of the soft tissue infection. The abdominal wall was only secondarily involved.

Conclusions: Even though perforated appendicitis as an etiology of a rapidly progressive soft tissue infection of the abdominal wall is very rare, it should be considered in the differential diagnosis of abdominal wall cellulitis. The distinction between rapidly spreading subcutaneous infection with abscess formation and early onset of necrotizing fasciitis is often difficult and can be confirmed only by surgical intervention.

Keywords: Abscess of the abdominal wall; Case report; Perforated appendicitis; Soft tissue infection.

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Figures

Fig. 1
Fig. 1
Computed tomography performed on the patient’s admission shows extensive emphysema in the subcutaneous tissue without any signs of an intraabdominal infection
Fig. 2
Fig. 2
Diagnostic laparoscopy without any signs of intraabdominal infection and ileocecal area adherent to the abdominal wall
Fig. 3
Fig. 3
Stool in the subcutaneous tissue from the perforated appendix
Fig. 4
Fig. 4
Situs after radical debridement of the subcutaneous tissue. However, the fascia is not involved. The arrow marks the site of the perforation through the abdominal wall
Fig. 5
Fig. 5
Timeline
See this image and copyright information in PMC

References

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