Fournier’s Gangrene and Extensive Abdominal Necrotizing Fasciitis Secondary to Perforated Appendicitis Within an Inguinoscrotal Hernia: A Rare Case Report

Abstract

Fournier's gangrene (FG) is a life-threatening necrotizing infection rarely triggered by an intra-abdominal process. We report an unusual case of FG and extensive abdominal necrotizing fasciitis secondary to a perforated appendix within an inguinoscrotal hernia. A 66-year-old male presented with a three-day history of progressive abdominal pain and systemic toxicity. Physical examination revealed abdominal contracture, extensive erythema, subcutaneous emphysema of the lower abdomen, and necrotic patches on the right scrotal skin. A computed tomography (CT) scan confirmed FG secondary to acute perforated appendicitis. The patient underwent emergency surgery via a combined midline laparotomy and scrotal approach, revealing purulent peritonitis and widespread tissue necrosis. Wide surgical excision and thorough debridement were performed. Postoperative management included broad-spectrum antibiotics and adjuvant hyperbaric oxygen therapy (HBOT). Tissue cultures grew a polymicrobial infection (Escherichia coli, Streptococcus spp., Pseudomonas aeruginosa, and Bacillus). Following intensive multidisciplinary care and sequential debridements, the patient's condition successfully stabilized. This case highlights the significance of recognizing Fournier's gangrene as a potential complication of an intra-abdominal septic process.