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Rare Manifestations of Acute Scrotum- A Case Report |
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Prince Gupta, Nitin Nagpal, Akshit Bansal, Nisha Singla 1. Senior Resident, Department of Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. 2. Professor and Head, Department of Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. 3. Junior Resident, Department of Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. 4. Senior Resident, Department of Pathology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. |
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Correspondence Address : Prince Gupta, House No. 57, Ward No.13, Dhuri, Punjab, India. E-mail: Gupta.prince1989@gmail.com |
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| ABSTRACT |  | ||||||||||||||
: Acute scrotum is referred to patients presenting with acute pain or swelling in scrotum or its contents. Clinical evaluation and appropriate radiological investigations helps us to pin point the aetiology of acute scrotum. Male genitourinary cases range from 0.5-2.5% of all emergency cases, although very few cases report the incidence of acute scrotum. Purpose of this case report is to highlight two very rarely reported events presented as scrotal pain and testicular swelling in a 39-year-old male and a 31-year-oldmale patient. After radiological examination a diagnosis of acute scrotum was made. Commonly causation is attributed to either acute torsion or acute epididymo-orchitis. Routinely, management of acute scrotum include colour doppler scrotum, based on its findings further treatment is decided either surgical exploration or conservative treatment. Early evaluation and timely management is imperative in preserving the viability of gonads. | |||||||||||||||
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| Keywords : Acute torsion, Scrotal pain, Surgical exploration, Testicular swelling | |||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2022/52033.2769
Date of Submission: Aug 21, 2021 Date of Peer Review: Nov 11, 2021 Date of Acceptance: Jan 08, 2022 Date of Publishing: Apr 01, 2022 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Aug 23, 2021 • Manual Googling: Jan 07, 2022 • iThenticate Software: Jan 20, 2022 (7%) Etymology: Author Origin |
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| Case Report |
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Case-1 A 39-year-old male presented in Surgery Department with left testicular pain and scrotal swelling for two days. Pain was severe, sudden in onset, continuous, non radiating and aggravated by movements. No history of similar complaints in past. On examination there was diffuse, indurated and tender left scrotal swelling. Ultrasound colour doppler showed rupture of left testis with herniation of non viable testicular tissue through a defect of around 10.9 mm with no parenchymal vascularity. Patient was diagnosed to have testicular rupture. Differential diagnosis includes left testicular torsion or left epididymo-orchitis. On exploration, in tunica albuginea on superomedial aspect of left testis (Table/Fig 1) pus and necrotic material coming out from defect was seen (Table/Fig 2). Patient was advised for surgical management. Surgical exploration along with left orchidectomy was done. On histopathological examination there was dense infiltration by acute inflammatory cells comprises of neutrophils. There were also seen areas of necrosis and haemorrhage (Table/Fig 3). Postoperatively there were no complications. There was no left testicular pain and no scrotal swelling on follow-up after one week of discharge. Case 2 A 31-year-old male presented to the Emergency Department with complaint of scrotal pain and lower abdominal pain for one day.There was alleged history of road side accident one day back. Pain was sudden in onset, severe in intensity and continuous. On examination overlying skin was normal, bilateral testicular tenderness and diffuse scrotal swelling was present. Ultrasound inguinoscrotal region show haematoma in bilateral testes (Table/Fig 4). Patient was diagnosed to have bilateral intratesticular haematoma. Treatment option was either conservative or surgical management. Patient was managed conservatively with scrotal elevation. Swelling reduced on day 3 and completely resolved on day 4 (Table/Fig 5). | |||||||||||||||
| Discussion |
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Acute scrotum is defined as acutely painful, swollen scrotum or its contents. Common causes of acute scrotum include testicular torsion, epididymo-orchitis, trauma, hernia (1). Atraumatic spontaneous testicular rupture is rare occurrence without any previous disease or can follow an episode of epididymo-orchitis’ (2). Male genitourinary cases range from 0.5-2.5% of all emergency cases (3). Only one case of non traumatic testicular rupture has been published so far. Epididymo-orchitis results in vascular insufficiency due to inflamed structures causing compression of vessels. Also, the toxins released from infectious source and inflammatory cascade result in increased vascular thrombosis lead to testicular infections and ultimately end result of testicular rupture (4). If vascularity is not compromised, it may help in salvage of the testis. However, if testis is necrotic, orchidectomy is treatment of choice. Intratesticular haematoma is another rare event and always proceeded by trauma. There is little data that specifically reports the incidence of intratesticular haematomas. If tunica albuginea of the affected testis is not ruptured in the intratesticular haematoma, it appears to involve a compartment syndrome (5). Small haematomas without any direct or indirect evidence of a testicular rupture are treated conservatively with ice packs, Non steroidal anti-inflammatory drugs and followup clinical testing and ultrasound evaluation (6). However, in large intratesticular haematomas surgical treatment in the form of drainage should be required. | |||||||||||||||
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