Fournier‘s gangrene as Amyand‘s hernia complication

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Authors: F. Sládek ¹; V. Krass ^1,2; O. Salaš ¹; M. Sutorý ^1,2; L. Paša ²
Authors place of work: Chirurgické oddělení, Úrazová nemocnice v Brně ¹; Klinika traumatologie Lékařské fakulty Masarykovy Univerzity Brno ²
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 7, s. 291-296.
Category: Kazuistika

Summary

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports.

Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia.

Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

Keywords:

inguinal hernia – Fournier’s gangrene – Amyand’s hernia – necrotizing fasciitis – gangrenous appendicitis

Zdroje

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