Rare scrotal manifestation of pancreatitis – The role of early differential diagnostics
Juhász Dániel dr., Nyirády Péter dr., Majoros Attila dr.
Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
Introduction: Acute scrotum is an acute condition associated with swelling of the testicles and pain, which can be caused by inflammation, trauma and torsion of testicles and testicular appendices. As a complication of the inflammation of the pancreas an abscess can occur. Scrotal involvement is a literary rarity. This is a case report of a patient with chronic pancreatitis, scrotal swelling and pain causing problem in early differential diagnostics.
Case report: A 49-year-old male patient with progressive left side scrotal and lower abdominal pain, left side testicular swelling and penis edema attended the outpatient’s clinic. Physical examination and ultrasonography (US) of testicles arose the possibility of genital inflammation, but the intact male adnexal morphology raised the possibility of secondary process. The abdominal and pelvic CT-scan showed a large left-sided retroperitoneal multiregional abscess system with a propagation towards the back muscles presuming a pancreatic origin. After a surgical drainage the patient could be treated conservatively.
Discussion and conclusion: Scrotal swelling and pain can occur in case of acute retroperitoneal abscess, which is a rare complication of pancreatitis. In case of acute scrotum, if the etiology is unclear secondary origin shall be assumed. As a result of the correct differential diagnostics, the patient received targeted conservative therapy and no scrotal exploration was needed. In case of acute scrotum, prior to perform surgical exploration of the scrotum, correct differential diagnostics and treatment should be performed, additional tests can clarify the diagnosis.