Fournier's gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring

Abstract

Fournier's gangrene (FG) requires prompt recognition and management. We report the case of a 68-year-old man who presented with extensive pain and purple discolouration from the right iliac fossa to perineum. Computed tomography demonstrated gas within the right hemiscrotum extending into the inguinal canal and right buttock, with a right pelvic fluid and air collection. At debridement necrotic fluid was arising from the superficial inguinal ring so laparotomy was performed, revealing a grossly inflamed appendix herniating into the inguinal canal; a right hemicolectomy was performed. Unfortunately, the patient went into cardiac arrest and passed away on the operating table. Histological analysis demonstrated acute-on-chronic inflammation involving the appendix. The condition where appendicitis is implicated in FG is usually due to retroperitoneal rupture and tracking into the perineal spaces. This is the first case reported of an inflamed appendix herniating into the inguinal canal and thus causing FG.

Figure 1:

Axial section CT image demonstrating loculated air within the right hemiscrotum.

Figure 2:

Coronal section CT image demonstrating extension of the loculated air superiorly into the inguinal canal and lower anterior abdominal wall and laterally into the right buttock. There is also a 10 × 4 × 6 cm fluid and air collection in the right pelvis.