Amyand’s hernia with appendicitis masquerading as Fournier’s gangrene: a case report and review of the literature

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.

Hernie De Amyand Compliquee De Gangrene De Fournier : A Propos D’un Cas Et Revue De La Litterature

“…La hernie de Claudius Amyand se définit par la présence au sein du sac herniaire de l'appendice normal, inflammatoire ou perforé (Sharma et al, 2007). C'est une entité rare, sa fréquence globale est de 0,1% (Rajaguru et al, 2016). Elle représente 1% des hernies étranglées contenant des viscères et 0,13% des formes d'appendicites (Ryan, 1937).…”

“…A Case Report and Review of the Litterature Introduction La hernie de Claudius Amyand se définit par la présence de l'appendice au sein d'un sac herniaire. C'est une entité rare (Rajaguru et Tan, 2016). Son évolution peut se faire vers un abcès, une péritonite généralisée.…”

Acute appendicitis located within Amyand’s hernia—a complex case with concurrent acute cholecystitis

“…Uncommonly, Amyand’s hernia can mimic acute scrotal pathology such as torsion or abscess [ 5 ]. With regards to acute appendicitis occurring inside the sac, either primary appendicitis can occur or prolonged incarceration of the appendix and pressure from the abdominal wall leads to inflammation of the appendix [ 6 ].…”

Perforated appendicitis as a source of Fournier’s gangrene in an immunocompetent male

“…He was discharged home with negative pressure wound dressing. 10 Fournier's gangrene can also affect young immunocompetent patients. In 2016, a case was reported of a 28 year old man admitted to urology department through the emergency department with an atypical history of acute scrotal swelling on a background of abdominal pain which was within 24 hour acute, rapidly progressing bilateral scrotal swelling, pain, and erythema.…”