Necrotizing Fasciitis of Abdominal Wall and Empyema Thoracis Complication from Appendicitis: Case Report and Review Literature

Abstract

Appendicitis is a common surgical disease with good result of treatment if early diagnosis and treatment. The delay in diagnosis and treatment often lead to severe complications. We report a 11-years-old boy presented with abdominal pain. The physical examination showed obese boy, tachypnea, tachycardia and tenderness of right abdomen. Laboratory showed leukocytosis and radiographic examination showed appendiceal abscess. Emergency exploratory laparotomy was performed; intraoperative finding showed rupture appendicitis, retroperitoneal abscess, necrotizing fasciitis of retroperitoneum and lateral wall abdomen. Appendectomy, drainage of abscess and excisional debridement of retroperitoneum and abdominal wall was performed. Postoperative, the patient developed respiratory failure and sepsis, the antibiotics was switched and the patient was transferred to PICU. Five days after operation the investigations showed empyema thoracis and pericardial effusion. Intercostal drainage was placed. Radiographic investigation after two weeks course of antibiotic revealed hydropneumothorax. Thoracotomy and decortication was performed. The post-operative course was uneventful and the patient was discharged from hospital. The patient was followed treatment for one year with eventful course and normal chest film.