Missed appendicitis presenting as necrotising fasciitis of the thigh

Acute appendicitis is one of the most commonly encountered surgical emergencies. It usually presents with typical symptoms; however, diagnostic doubt may be encountered in atypical presentations. Rarely, complicated appendicitis may manifest as necrotising fasciitis (NF), further complicating the diagnosis and management. This case illustrates an atypical presentation where the diagnosis of appendicitis was initially missed. This report explores the pathophysiology, diagnostic challenges, and management principles when appendicitis presents as NF.