Acute appendicitis complicated with necrotizing soft tissue infections in the elderly: Report of a case

A case of acute appendicitis complicated with necrotizing soft tissue infec tions (NSTIs) in an extremely elderly woman (98 years-old) is reported. She was admitted to our hospital with a history of increasing pain localized i n the right lower abdomen. Abdominal ultrasonography revealed appendicolith iasis and periappendiceal fluid. An appendectomy and closure of the perfora ted cecum was performed. On the 5th post-operative day, the patient develop ed skin erythemas and crepitation in the right lower quadrant. An explorati on and drainage of the recent operative incision was performed under the di agnosis of NSTIs. Despite the declining overall incidence of appendicitis, it has been increa sing among the elderly. The elderly patients are associated with underlying defects in immune function. NSTIs, which are characterized by rapidly prog ressing inflammation and necrosis of soft tissue, comprise a spectrum of di sease ranging from necrosis of the skin to life-threatening infections. The most common etiology of NSTIs was post-operative infections of the abdomin al wall, which primarily occurred after operations with extensive fecal con tamination. NSTIs are no longer a rare post-operative complication in the elderly and i nitial treatment should be selected according to the condition of the patie nt.