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.
Subject(s)
Abdominal Wall/pathology , Anti-Bacterial Agents/administration & dosage , Appendicitis/surgery , Escherichia coli Infections/diagnosis , Penicillanic Acid/analogs & derivatives , Peritonitis/diagnosis , Soft Tissue Infections/diagnosis , Abdominal Pain/diagnostic imaging , Abdominal Pain/pathology , Abdominal Wall/microbiology , Appendectomy/methods , Appendicitis/microbiology , Appendicitis/pathology , Emphysema/diagnostic imaging , Emphysema/pathology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/surgery , Female , Humans , Middle Aged , Penicillanic Acid/administration & dosage , Peritonitis/drug therapy , Peritonitis/surgery , Piperacillin/administration & dosage , Piperacillin, Tazobactam Drug Combination , Reoperation , Soft Tissue Infections/drug therapy , Soft Tissue Infections/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Segmental arterial mediolysis (SAM) is a non-arteriosclerotic, non-inflammatory arteriopathy characterised by dissecting aneurysms and most commonly found in abdominal arteries. A rupture of a visceral artery aneurysm is generally associated with high mortality. We present the case of a 57-year-old woman with a rupture of an intrahepatic aneurysm that led to intra-abdominal haemorrhage. The patient was surgically treated by evacuating the abdominal haematoma and ligature of the right hepatic artery. Histology of the right hepatic artery revealed the diagnosis of SAM. Six months postoperatively, the patient was in excellent physical condition with normal liver function and arterial blood flow of the right hepatic sections over collateral circulation.