Necrotising Fasciitis of the Abdominal Wall After Laparoscopic Appendicectomy: A Review of Published Cases

Abstract

Background: Necrotising fasciitis (NF) is a rare but frequently fatal complication of laparoscopic appendicectomy, one of the
commonest emergency operations performed worldwide. Objective: To review published case reports of NF after laparoscopic appendicectomy and related port-site/appendicitis-associated abdominal-wall NF, alongside the epidemiology, pathophysiology, diagnosis and management literature for necrotising soft tissue infection (NSTI) in this setting. Methods: Narrative review of individually verified case reports, epidemiological cohorts, microbiological and outcome studies, and society management guidelines.
Findings: Ten published cases were tabulated; onset ranged from postoperative day 2 to several weeks, infections were typically
polymicrobial (E. coli, Bacteroides, Klebsiella, anaerobes), and four of nine cases with a stated outcome were fatal. Laboratory Risk
Indicator for Necrotizing Fasciitis (LRINEC) scores, reported only in recent cases, correlated poorly with disease severity.
Conclusions: A high index of suspicion, disproportionate pain or systemic toxicity out of keeping with local findings, and
immediate surgical exploration rather than reliance on scoring systems or imaging remain the determinants of survival.