PDF(Pubmed)
Abstract：
Acute appendicitis is considered one of the most common surgical emergencies with low morbidity and mortality. However, delay in the diagnosis may lead to perforation of the appendix. Hence, complications may arise, including necrotizing fasciitis, a rare complication of a perforated appendix. We present a case of perforated appendicitis complicated by necrotizing fasciitis leading to rapid deterioration. A 75-year-old male patient presented to our emergency room with a three-day history of right lower quadrant abdominal pain and abdominal distention. On admission, computed tomography (CT) scan showed a perforated appendix and peri-appendicular abscess. An exploratory laparotomy was performed. The appendix was resected and the wound closed. The patient was recovering well and tolerating food after the procedure. However, the patient developed progressive erythema/swelling over the right flank with new-onset leukocytosis. The diagnosis of necrotizing fasciitis was suspected and confirmed by careful evaluation and laboratory/radiological tests. Antibiotics were changed to clindamycin and piperacillin/tazobactam, and the patient was taken back to the operation room (OR) for surgical debridement. Postoperatively, the patient was shifted to the intensive care unit (ICU). He developed hearing impairment, which improved after the cessation of clindamycin. He was discharged in good condition after three weeks of hospital stay. This case report highlights the importance of maintaining a high index of suspicion for necrotizing soft tissue infection in immunocompromised patients with perforated appendicitis and being cautious when prescribing clindamycin to patients at risk of hearing loss.
摘要：
急性阑尾炎被认为是最常见的外科急症之一，发病率和死亡率低。然而,诊断延迟可能导致阑尾穿孔。因此，可能会出现并发症，包括坏死性筋膜炎,阑尾穿孔的罕见并发症。我们介绍了一例穿孔性阑尾炎并发坏死性筋膜炎导致快速恶化的病例。一名75岁的男性患者出现在我们的急诊室，有三天的右下腹腹痛和腹胀病史。一入场,计算机断层扫描(CT)扫描显示阑尾穿孔和阑尾周围脓肿.进行了剖腹探查术。切除阑尾并闭合伤口。手术后，患者恢复良好，可以忍受食物。然而,患者右侧出现进行性红斑/肿胀,并出现新发白细胞增多.怀疑诊断为坏死性筋膜炎，并通过仔细评估和实验室/放射学检查确认。抗生素改为克林霉素和哌拉西林/他唑巴坦，并将患者带回手术室（OR）进行手术清创。术后,患者被转移至重症监护病房(ICU).他出现了听力障碍,停止克林霉素后有所改善。住院三周后，他的情况良好。此病例报告强调了在患有穿孔性阑尾炎的免疫功能低下患者中保持对坏死性软组织感染的高怀疑指数的重要性，并在向有听力损失风险的患者开具克林霉素时要谨慎。
