• Kishore Rajaguru and Daniel Tan Ee Lee.
• Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore. kishoreguru86@gmail.com.
• J Med Case Rep. 2016 Sep 22; 10 (1): 263.

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.

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