Retroperitoneal Necrotizing Fasciitis Secondary to Ruptured Appendicitis-Two Cases Report

Abstract

Appendicitis is a common disease of acute abdomen, and retroperitoneal necrotizing fasciitis (RNF) which means infection involved the retro peritoneal space is the relatively rare and fatal complications reported so far as we know. We present two cases affected by RNF due to perforated appendicitis and review the related literatures to identify the possible mechanism, risk factors and therapeutic strategies. The first patient was transferred to our hospital due to RNF after open appendectomy for acute ruptured appendicitis. The other case is a type 2 DM patient and has been bothered by obstinate abscess formation over right flank for a long period of time. Chronic appendicitis complicated with RNF was diagnosed finally although no abdominal symptoms were associated with it. Both of them received surgical and medical therapy, and has no recurrence after our treatment. In conclusion, immunocompromised status and intra-abdominal comorbidities are high risk factors. Both of the acute and chronic appendicitis may result in the lethal necrotizing fasciitis spreading along the retroperitoneal space similarly. Early and prompt wide debridement, broad-spectrum antibiotic therapy, constructive resuscitation, and prevention of nosocomial infection may improve the survival rate.