Presentation
Abdominal pain.
Patient Data
Abnormal, perforated appendix replaced by inflammation, air, and fluid. Extensive right retroperitoneal and anterior pelvic extraperitoneal spread of air/fluid with peritoneal thickening/enhancement. Fluid/air extends into the space of Retzius and along the right pelvis sidewall. Reactive thickening of the urinary bladder. Small ascites. Aside from the perforated appendix, no other intraperitoneal collections.
Case Discussion
Unusual pattern of perforated appendicitis which primarily spread and dissected through the RETRO/EXTRAperitoneal space, resulting in necrotizing fasciitis and emergency surgery with extensive debridement and drainage of these collections. It is essential to make this distinction and guide the surgeons accordingly who otherwise would primarily focus their evaluation on the intraperitoneal cavity.
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