PMC5742009_01
Photograph showing the large wound with sloughing of the skin in the lateral abdominal and thigh regions.
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On the second day of hospitalization, after initial stabilization he presented with a fever, low blood pressure, abdominal discomfort, and necrotic wound of the right abdominal wall, groin, and thigh (Fig. 1).
CT-Scan showing gas and fluid collection extending from his retroperitoneal space to the subcutaneous layer of his right groin and abdominal wall, without identification of the appendix.
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An abdominal ultrasonogram showed a mild amount of fluids with echoes in suspension in the abdominal cavity, and the CT scan showed gas and fluid collection extending from his retroperitoneal space to the subcutaneous layer of his right groin and abdominal wall (Fig. 2), without identification of the Appendix or free gas in the perihepatic and perisplenic spaces.
Photograph showing the tip of the Appendix entering the retroperitoneal space in the region of the necrotic wound in the abdominal wall.
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Appendix and its tip invaded the posterior lateral abdominal wall in the area of the necrotic wound; the stumps of the Appendix were preserved (Fig. 3), and about 200 mL of abdominal serous fluid was collected with debris. Appendectomy was performed with ligation, transfixation, and inversion of the appendicular stumps, and the tip was excised up to the retroperitoneum and lateral abdominal wall.