Fournier’s gangrene secondary to acute perforated appendix in Amyand’s hernia in an older adult

Abstract

Introduction: Amyand’s Hernia is rare; it is commonly diagnosed during transoperative period, while Fournier’s gangrene is an acute infection affecting the scrotum, penis and perineum aggravated by gram-negative organisms, enteric and anaerobic bacilli, usually resulting from a local trauma, surgical procedures or urinary tract infection, it is not frequent and has a fatal diagnosis.

Case Report: a 93-year-old man who suffered a trauma on the inguinal region where he had an inguinal hernia, 21 days after the trauma he started a septic infection that affected the perineum and right testicle; necrectomy, right orchiectomy and herniorrhaphy were completed. Given the discharge of pus through the inguinal channel, a laparotomy was necessary to provide evidences that the origin of gangrene was secondary to a perforated appendix due to a fecalith in the hernial sac, after his recovery a differed closing of the scrotal bursa was performed.   

Conclusions: Amyand’s hernia and Fournier’s gangrene both are of rare presentation, but both simultaneously is not frequent, besides the fact of having achieved the survival of an old man, was the motivation to present this case, as an achievement of medical practice when the patient is properly managed by health professionals.