Rajaguru Kishore, Tan Ee Lee Daniel
Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore.
J Med Case Rep. 2016 Sep 22;10(1):263. doi: 10.1186/s13256-016-1046-9.
The 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.
This 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.
A 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.
阑尾被嵌顿于腹股沟疝囊内称为阿米亚德疝。阿米亚德疝合并阑尾炎占所有病例的0.1%。一种侵袭性的生殖器和会阴部坏死性感染，称为福尼尔坏疽，可迅速发展为败血症并导致死亡。我们描述了一例罕见的福尼尔坏疽合并阿米亚德腹股沟疝的病例，该病例在文献中鲜有报道。
本病例报告描述了一名47岁中国男性的临床表现及治疗过程，该患者右腹股沟阴囊区有脓性分泌物并伴有下腹部疼痛，具有福尼尔坏疽的临床体征。手术探查发现，复杂的阿米亚德疝（洛萨诺夫和巴森分类4型）是其福尼尔坏疽的病因。
腹股沟疝内的穿孔阑尾导致福尼尔坏疽在临床实践中很少见。这种情况几乎总是在手术中做出诊断。早期识别并意识到腹股沟疝囊内的穿孔阑尾炎是福尼尔坏疽的病因之一，以及在此类病例中采用良好的手术技术是处理这一外科问题成功的关键。在复杂的阿米亚德疝病例中，行阑尾切除术并进行解剖修复是最佳治疗方法。最好避免使用补片修补术。
