Abstract
BackgroundThe incarceration of an appendix within an inguinal hernia sac is known as Amyand’s hernia. Appendicitis in Amyand’s hernia accounts for 0.1 % of the cases. An aggressive necrotizing infection of the genitalia and perineum, called Fournier’s gangrene, can rapidly progress to sepsis and death. We describe a rare case of Fournier’s gangrene complicating Amyand’s inguinal hernia which has rarely been reported in the literature.Case presentationThis case report describes the presentation and management of a 47-year-old Chinese man who presented with pus discharge from his right inguinoscrotal region and lower abdominal pain with clinical signs of Fournier’s gangrene. On surgical exploration, a complicated Amyand’s hernia (Losanoff and Basson classification type 4) was found to be the cause of his Fournier’s gangrene.ConclusionsA perforated appendix within an inguinal hernia causing Fournier’s gangrene is rarely seen in clinical practice. The diagnosis of this condition is almost always made intraoperatively. Early recognition and awareness of perforated appendicitis within an inguinal hernia sac as one of the causes of Fournier’s gangrene and good surgical technique in such cases are the keys to success when dealing with this surgical issue. In complicated presentations of Amyand’s hernia, an appendicectomy with anatomical repair is the best treatment. It is better to avoid meshplasty.
Highlights
The incarceration of an appendix within an inguinal hernia sac is known as Amyand’s hernia
Recognition and awareness of perforated appendicitis within an inguinal hernia sac as one of the causes of Fournier’s gangrene and good surgical technique in such cases are the keys to success when dealing with this surgical issue
Fournier’s gangrene is a rapidly progressive necrotizing infection of the perineum and the genitalia with occasional extension to the anterior abdominal wall. It is a surgical emergency characterized by a synergistic necrotizing fasciitis and the infection usually spreads along the subcutaneous and fascial planes, myonecrosis is rare
Summary
The incarceration of an appendix within an inguinal hernia sac is known as Amyand’s hernia. Fournier’s gangrene complicating Amyand’s inguinal hernia has rarely been reported in the literature. Delay in surgical intervention contributes to increased morbidity and mortality. This case report explains the features, pathophysiology, and the importance of surgical intervention in this rare condition and it improves awareness of the presence of perforated appendicitis within an inguinal hernia sac, which is one of the rarer causes of Fournier’s gangrene. Authors’ contributions RK drafted the manuscript; TD supervised the writing of the manuscript. Both authors read and approved the final manuscript. Consent for publication Written informed consent was obtained from the patient's next-of-kin for publication of this case report and any accompanying images. Ethics approval and consent to participate Not applicable since it is a case report
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