Fournier's gangrene secondary to appendicectomy

Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the scrotum. Case report: A 33-year-old male presented in the Accident and Emergency department of Living Word Mission Hospital with a few days history of painful scrotum with desquamation of the epithelium of the scrotal skin. He gave a history of an appendicectomy for a ruptured appendix carried out 8 days earlier at another hospital. Examination revealed a dehisced appendicectomy wound and a de-epithelialized distal scrotal skin. A diagnosis of Fournier's gangrene was made. He was commenced on potent antibiotics and had debridement of the scrotal wound. The wound improved with healthy granulation tissue and it was then covered with a split skin graft. Lesson: When the appendix is found to be ruptured at operation; potent antibiotics are required to forestall the spread of the infection in the peritoneum or along the fascial planes causing necrotising fasciitis

Is it necessary to perform appendicectomy in the middle of the night in children?

To compare between the complications after appendicectomy for patients whom operated upon within six hours from admission and those observed overnight and who had appendicectomy 6-18h after admission. This study included 1390 Patients-902<450boys> operated on within six hours and 388<190>boys operated on 6-18 hours after admission. Diagnoses included acute appendicitis in 325<72%> Patients perforated appendix in 8l,and normal appendix 45<10%> in the group operated on within six hours and 169<69%>, 50<21%>and 25<10%> in the group whose operation was delayed. Although early appendicectomy remains the treatment of choice it can be safely postponed overnight without increasing morbidity and mortality