Necrotizing Fasciitis Following Complicated Acute Appendicitis in a Pediatric Patient: A Case Report

Abstract

Acute appendicitis, the leading cause of emergency abdominal surgery in pediatrics, can progress to severe complications such as perforation and abscess formation. In male patients with a persistent processus vaginalis, the communication between the peritoneal cavity and the scrotal sac allows the migration of infected material, resulting in a scrotal abscess and, rarely, necrotizing fasciitis, a condition associated with high morbidity and mortality. This report describes a case of complicated acute appendicitis in an adolescent, with infectious spread to the scrotum and progression to necrotizing fasciitis, highlighting the importance of early diagnosis and multidisciplinary management The patient had experienced abdominal pain for 10 days and testicular pain for 48 hours, with a history of right inguinal hernia. On physical examination, there was tenderness in the right iliac fossa, scrotal erythema, and a firm right testicle. Laboratory tests revealed leukocytosis and elevated C-reactive protein (CRP). Computed tomography (CT) confirmed a perforated appendicitis with pneumoperitoneum. An emergency appendectomy was performed, revealing a necrotic appendix and purulent peritonitis. On the third postoperative day, the patient developed scrotal fasciitis, characterized by purulent drainage and crepitus, requiring extensive surgical debridement and antibiotic therapy. He showed progressive clinical improvement and was discharged after 10 days. This report emphasizes the importance of considering atypical complications, such as scrotal abscess and necrotizing fasciitis, in pediatric patients with acute appendicitis and anatomical risk factors (persistent processus vaginalis). Early diagnosis, based on clinical-laboratory evaluation and imaging, combined with appendectomy, surgical drainage, and appropriate antibiotic therapy, is crucial to reduce morbidity. Clinicians should maintain a high index of suspicion in cases of testicular pain associated with abdominal signs to optimize clinical outcomes.