Amyand's Hernia With Mixed Content, Cecal Perforation, and Fournier's Gangrene: A Case Report and Literature Review

Amyand's hernia is defined by the presence of the vermiform appendix within an inguinal hernia sac and occurs in fewer than 1% of all inguinal hernias. When the appendix is inflamed or perforated, the incidence decreases to 0.1%, and when additional intra-abdominal organs are involved, the condition becomes exceptionally rare. We present the case of a 62-year-old man with a 10-year history of an untreated right-sided inguinoscrotal hernia who presented to the emergency department with a five-day history of progressive scrotal swelling, discoloration, pain, and inability to defecate or tolerate oral intake. Examination revealed a 17 × 10 cm inguinoscrotal mass with violaceous skin discoloration and visible necrosis at the scrotal base. Plain abdominal radiographs showed air-fluid levels consistent with small bowel obstruction. Emergency laparotomy confirmed a Losanoff-Basson type 4 Amyand's hernia with right-sided mixed hernial contents extending 370 cm from the angle of Treitz into the scrotum, including the cecum, appendix, and terminal ileum, with cecal perforation, appendiceal compromise, fecaloid spillage, and Fournier's gangrene of the scrotum​​​, with approximately 30 cm of small bowel.​​ Surgical management included resection of the small bowel at 340 cm from the angle of Treitz with a colonic pouch, terminal ileum ileostomy, right orchiectomy, scrotal debridement with repeated surgical washouts, and primary hernia defect repair without mesh. The patient underwent five additional surgical washouts during a 33-day hospitalization, followed by intestinal transit restoration during outpatient follow-up. To our knowledge, this case represents one of the most anatomically extensive right-sided Amyand's hernias with simultaneous cecal perforation and Fournier's gangrene reported in the indexed literature. Early surgical recognition and aggressive multivisceral management were the determining factors in the patient's survival.