Fournier Gangrene, Empyema and Retroperitoneal Abscess as a Rare Complication of Perforated Appendicitis: A Case Report

Abstract

Background: Perforated appendicitis which may be associated with the formation of localized abscess in the right iliac fossa or in the pelvic cavity, can be managed depending on their symptoms. Retroperitoneal abscess is a life-threatening condition because of its clinical manifestations and diagnostic difficulty. The retroperitoneal abscess has the potential to spread rapidly to the perinephric space, the psoas muscle, the lateral abdominal wall, and the lower extremities. Case presentation:We present a 39 years old patient who presented to the emergency room with empyema and retroperitoneal abscess which managed conservatively with percutaneous drainage and Intravenous antibiotics. After couple of days of observation, he developed Fournier gangrene which managed by surgical debridement. CT scan on the follow up showed intraabdominal collection, emergency exploratory laparotomy along with appendectomy and washout performed. Postoperatively the patient developed perineal wound bleeding which controlled surgically. Afterwards he became severely septic, requiring maximum ionotropic support. Eventually he died due to irreversible septic shock and multiorgan failure. Conclusion:Perforated appendicitis can present with variety of complications. To the best of our knowledge from the literature review, this is the first case to be reported as Fournier gangrene, empyema and retroperitoneal abscess as unusual complication of perforated appendicitis.

Fournier Gangrene and Retroperitoneal Abscess Secondary to Perforated Appendicitis: A Case Report

“…Delayed management of perforated appendicitis can lead to serious complications including localized retroperitoneal abscess or pelvic cavity abscess or can lead to Fournier's gangrene [4,6]. Retroperitoneal abscess with its clinical manifestations and diagnostic difficulty is considered a life-threatening complication due to its rapid spread to the perinephric space, the psoas muscle, the lateral abdominal pain and the lower extremities [1]. Fournier's gangrene is a necrotizing infection that is mainly caused by anaerobes such as Group A Streptococcus, Staphylococcus aureus and Clostridium perfringens.…”

“…Acute appendicitis is one of the most common abdominal emergencies worldwide that can achieve a good prognosis with early detection and management [1]. Fournier's gangrene is a rare but aggressive form of external genitalia or perineal extensive fulminant infection, which can occur as a complication of delayed presentation and subsequent delayed management of perforated appendicitis [2,3].…”

Retroperitoneal Abscess: A Case Series and Literature Review

“…The probable causes include perforated appendix, colorectal carcinoma, diverticular disease, Crohn's disease, and ingestion of foreign body. (Aljohani et al, 2020;Hesketh et al, 2021;Parikh et al, 2018) Any disease within retroperitoneal spaces is possible to be perforated. One of the example is colorectal carcinoma which develops retroperitoneal abscess by invading the muscle layer.…”

“…Gram staining, ascites fluid culture, and histopathological examination on biopsy-sample obtained laparoscopy are superior diagnostic tests in confirming the exact aetiology of retroperitoneal abscess. (Aljohani et al, 2020;Palacios-Zertuche et al, 2016) Radiography remains as the most effective diagnostic tool to detect retroperitoneal abscess, such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and abdominal sonography. (Huang et al, 2015) The accuracy rate of CT-Scan to diagnose retroperitoneal abscess is 100% hence CT-Scan becomes the gold standard for diagnosis.…”

“…(Huang et al, 2015) The adjacent organs are potential to be infected rapidly such as perinephric space, the psoas muscle, lateral abdominal wall, and the lower extremities. (Aljohani et al, 2020) Management of retroperitoneal abscess can be conservatively delivered by using pharmacology treatment such as antibiotic, as also operative treatment as the definitive management. (Mosquera et al, 2019) This study aimed to describes four patients with retroperitoneal abscess and discuss the clinical manifestation and treatment of retroperitoneal abscess.…”