Delayed presentation of retrocecal appendicitis in a low-resource setting causing necrotizing lumbar infection and spontaneous colocutaneous fistula: a case report.

Retrocecal appendicitis can present atypically, resulting in delayed diagnosis and potentially severe complications. I report a 43-year-old man who developed a foul-smelling right lumbar wound following two weeks of abdominal pain and swelling. Abdominal computed tomography revealed extensive necrotizing soft tissue infection secondary to a retrocecal inflammatory process, complicated by spontaneous colocutaneous fistula formation. Exploratory laparotomy revealed cecal perforation at the appendiceal base with posterior abdominal wall extension. Right hemicolectomy, ileotransverse anastomosis, lavage, and debridement were performed. Histopathology showed acute and chronic inflammation without malignancy. This case underscores the critical role of early imaging and prompt surgical management in atypical appendicitis to prevent severe complications.