Perforated Type III Amyand's Hernia With Retroperitoneal and Scrotal Abscesses and Testicular Ischemia Requiring Orchiectomy: A Case Report.

Amyand's hernia is defined as the presence of the vermiform appendix within an inguinal hernia and becomes particularly challenging when appendicitis progresses to perforation and extra-abdominal sepsis. We report a 60-year-old man with one week of progressive abdominal pain, reduced appetite, constipation, and impaired ambulation followed by three days of painful right inguinoscrotal enlargement. Examination showed an irreducible, inflamed right inguinoscrotal mass. Laboratory testing demonstrated leukocytes of 19.35 × 10³/µL, neutrophils of 92%, and bands of 13%. Ultrasonography showed a right inguinal wall defect with non-reducing omentum and bowel and complex scrotal contents. Emergency inguinal exploration drained approximately 400 mL of frank purulent material and demonstrated severe ischemic changes of the right spermatic cord and testis. Given the extent of the operative findings, midline laparotomy was performed; a retroperitoneal abscess communicating with the inguinal region and a gangrenous perforated appendix were identified, with the perforation approximately 1.5 cm from the appendiceal base. Appendectomy, retroperitoneal and scrotal drainage, Penrose drain placement, right orchiectomy for nonviability, and Shouldice tissue repair without mesh were performed. Recovery was favorable without known immediate complications. This case illustrates a severe Type III Amyand's hernia with simultaneous retroperitoneal and inguinoscrotal septic extension and irreversible testicular ischemia. In grossly contaminated presentations, prompt source control, excision of nonviable tissue, and nonprosthetic hernia repair remain pragmatic priorities.