Management of an Amyand's hernia complicated by necrotizing soft tissue infection: a case report.

Inguinoscrotal hernias account for ~2.7% of all inguinal hernias. Rare presentation limits the development of management guidelines for complex presentations of the condition. This case report reviews the management of an inguinoscrotal hernia containing perforated appendicitis with resultant necrotizing fasciitis. A 59-year-old male presented to the emergency department with worsening pain and edema in the right inguinal canal. Imaging revealed perforated appendicitis contained within an inguinoscrotal hernia, complicated by air in the abdominal wall consistent with necrotizing fasciitis. The patient was taken to the operating room for extensive wound debridement, appendectomy and orchiectomy with interval definitive hernia repair 48-h after index operation. This case demonstrates our success with a single 48-h operative interval, extended antibiotic course and biological mesh placement in the context of complicated inguinal hernia repair. Our experience with this patient should aim to inform future management of patients with similar conditions.