Appendectomies are routine procedures done with minimal complications. However, the diagnosis of acute appendicitis may be complicated by its' varied presentations. Although extremely rare, a perforated appendix is capable of causing the often fatal necrotizing fasciitis infection. Case Report: A 42-year-old hypotensive, tachycardic female with acute abdominal pain was brought to the operating room after CT findings were suspicious for acute appendicitis. Laparoscopic dissection revealed that

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... e appendix had eroded through the abdominal wall, potentially through a hernia defect or a defect created by the infection and resulting inflammation. The appendix was removed and a drain was left in the right pericolic gutter. The patient was repositioned and a 10 cm incision was made in the right flank where a large amount of necrotic foul-smelling tissue and fluid was removed. Bacterial culture of the pus grew Peptostreptococcus and Escherichia coli. After clearing a significant amount of necrotic tissue and receiving a bedside consultation from orthopedics, the wound was packed. Conclusion: Necrotizing fasciitis is a rare, serious disease that is capable of, although very rarely, being caused by a perforated appendix. The high mortality rate associated with necrotizing fasciitis caused by appendicitis highlights the need for early diagnosis, broad-spectrum antibiotic treatment as well as timely surgical debridement to maximize chance of survival.