Scrotal abscess primarily develops as a complication of severe epididymitis and/or orchitis. Undiagnosed or neglected testicular torsion is another important diagnosis that predisposes the pediatric population to the development of scrotal abscess. The clinical presentation is centered around scrotal swelling, pain, locally increased temperature, and erythema, whereas lower abdominal pain might be present in some patients. Ultrasonography is the gold standard for evaluating scrotal pathology, coupled with a detailed clinical assessment.
Scrotal abscess is considered to be a rare phenomenon in general practice   . This inflammatory condition usually stems from complicated infections of the scrotum, such as epididymitis and orchitis (particularly the necrotized forms), which can be caused by several bacterial pathogens (Escherichia coli in younger patients; Chlamydia trachomatis and Neisseria gonorrhoeae in sexually active individuals) and mumps virus.     . Furthermore, secondary infections with pus formation in the scrotum have been described as a consequence of the hematogenous spread of systemic infections, neglected testicular torsion, or as a complication of acute appendicitis in rare cases   . Certain congenital malformations might predispose individuals to a scrotal abscess. For example, a patent processus vaginalis can allow a passage of pus from a pyogenic process in abdominal cavity into the scrotum  . The clinical presentation mainly consists of localized symptoms - scrotal pain that is often severe, erythema of the scrotum, and profound tenderness accompanied by heat and swelling . In some patients, lower abdominal pain, fever, and vomiting may be present .
Entire Body System
- Hodgkin Lymphoma
Primary extranodal non-Hodgkin's lymphomas. Part 1: Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol. 1997;8(8):727-37. (Review article). View the reference Adeyoju AB, Collins GN, Pollard AJ, Liaw J, Brooman PJ, O'Reilly PH. [imagingpathways.health.wa.gov.au]
- Weight Loss
May have back or flank pain, dyspnoea, supraclavicular lymphadenopathy, abdominal mass (enlarged para-aortic lymph nodes), weight loss, gynaecomastia, epididymo-orchitis, or hydrocele. [patient.info]
His medical history is significant for mild hypertension and morbid obesity, but he is not immunocompromised. [mdedge.com]
Lastly, scrotal edema secondary to hypoalbuminemia, portal hypertension and lymphadenopathy are also rare but significant conditions that may occur under the aegis of the acute scrotum. [auanet.org]
- Skin Thickening
thickening important to assess for scrotal wall abscesses occasionally intrascrotal gas may be present Nuclear medicine Pertechnetate scintigraphy shows increased perfusion but decreased uptake centrally within the testis at the necrotic core of the [radiopaedia.org]
Sonogram of the scrotum shows nonspecific skin thickening (arrow). 4. Scrotal abscess. [radcharts.org]
As with other types of acute scrotal pathology, reactive hydrocele and skin thickening can also be observed. [iame.com]
The affected side can be larger from the swollen testis itself, a hydrocele or skin thickening. Gray scale Ultrasound Gray scale ultrasound is helpfull, not in making the diagnosis, but in predicting the outcome. [radiologyassistant.nl]
US will show a circular mass adjacent to the testis or epididymis which may show peripheral increased flow on color Doppler examination; reactive hydrocele and skin thickening may also be shown [ 28 ]. [criticalultrasoundjournal.springeropen.com]
- Scrotal Pain
Acute scrotal pain and swelling in children is commonly attributed to torsion of the testis or of the testicular appendage. However, following suppurative appendicitis, scrotal abscess secondary to a patent processus vaginalis must be considered. [ncbi.nlm.nih.gov]
* Scrotal pain and swelling: The epididymis swells to often twice normal size within 3-4 hours (the degree of swelling is variable). * Pain on urination * Discharge from your urethra (at the end of your penis; especially in men younger than 35 years [justanswer.com]
Ultrasound Evaluation of Acute Scrotal Pain (Matthew T. Heller, MD) Click here to take the quiz. [iame.com]
The diagnostic workup of scrotal abscess starts with a detailed clinical assessment comprised of two components - a detailed patient history that covers the course and progression of symptoms and a meticulous physical examination that identifies the source of inflammation and associated complaints. If these steps are properly performed, they should be sufficient to make a presumptive diagnosis. In fact, the scrotal tenderness experienced by patients might be severe enough to impede palpation and detailed evaluation, thus inspection of the affected scrotum is frequently enough to raise solid suspicion .
Because the differential diagnosis may be broad (in addition to intrascrotal infections and congenital malformations, squamous cell carcinoma of the scrotum is a rare, but very important etiology of scrotal symptoms) , laboratory and imaging studies need to be employed. Laboratory tests can reveal leukocytosis and elevated inflammatory parameters . Ultrasonography is the gold-standard for assessing scrotal pathologies and should be performed in all patients  . Typical characteristics of scrotal abscess include fluid collection with a hypervascular margin and irregular walls   . In the case of an infection, the underlying cause should be investigated through microbiological methods.
RESULTS A 3-year-old child reared as male presented with pyuria, left recurrent scrotal abscesses and mid penile hypospadias. [ncbi.nlm.nih.gov]
Pain should be relieved with scrotal elevation (positive Prehn sign) and the cremaster reflex is intact. Urinalysis may show pyuria but it’s absence does not rule out epididymitis. Urine culture and urethral cultures may reveal the causative pathogen [ispub.com]
Stanford 2 doctors agreed: 1 1 Bartholin abscess - treatment time with antibiotics vs drainage? Dr. Julia Stanford Dr. Stanford 2 doctors agreed: Treatment time: For most abscesses, treatment is faster with drainage vs just taking an antibiotic. [healthtap.com]
We present the case of a patient experiencing extensive sterile abscess of the scrotum after nine months of treatment with vemurafenib for oligometastatic (liver) BRAF-mutant melanoma. [ncbi.nlm.nih.gov]
When diagnosed and treated early, the condition responds very well to available treatments. However, when left untreated or when treatment is delayed, it can lead to a number of complications. The infection can become chronic. [docdoc.com.sg]
After a proper diagnosis has been found, adequate treatment can begin. A doctor will treat a scrotal abscess in a number of ways depending on what is the underlying cause of the infection. [mademan.com]
Treatment Rest is advised. Inflammation is reduced by giving anti inflammatory drugs. Cold ice packs may be applied over the affected side. Bacterial infections require appropriate antibiotics. [buddymd.com]
Treatment and prognosis Complications Further possible complications from an epididymal abscess rupture with focal testicular ischemia or infarction inflammatory ulceration of the efferent ductules or the ductus epididymis may allow sperm to extravasate [radiopaedia.org]
Mortality is often related to the onset of sepsis.4,5 Survival requires early recognition; immediate, aggressive surgical debridement of all necrotic tissue; and concomitant, early administration of appropriate antibiotics.1,4,5,8 Mortality risk and prognosis [mdedge.com]
Prognosis and Patient Counseling. Prognosis is highly dependent on pathology and staging of radical orchiectomy specimen. [clinicaladvisor.com]
If treated appropriately with antibiotics, epididymitis should be cured and the individual will have an excellent prognosis (outlook). The pain should improve within 1-3 days; however, swelling may take several days to resolve. [emedicinehealth.com]
A retrospective review of two cases of scrotal abscess following appendectomy at our hospital as well as a MEDLINE search was performed to review the clinical presentation, etiology, type of treatment, and outcome of these patients. [ncbi.nlm.nih.gov]
Because the differential diagnosis may be broad (in addition to intrascrotal infections and congenital malformations, squamous cell carcinoma of the scrotum is a rare, but very important etiology of scrotal symptoms), laboratory and imaging studies need [symptoma.com]
A␣retrospective review of two cases of scrotal abscess following appendectomy at our hospital as well as a MEDLINE search was performed to review the clinical presentation, etiology, type of treatment, and outcome of these patients. [link.springer.com]
Urinalysis, urine culture and complete blood count help to differentiate infectious etiologies from non-infectious etiologies. Furthermore, in the case of infectious etiologies, urine culture results guide antimicrobrial selection. [clinicaladvisor.com]
The etiology of superficial scrotal abscess is infected hair follicles and infections of scrotal lacerations or minor scrotal surgeries. [emedicine.medscape.com]
Linguistic Variant - Portuguese, Brazil) 2015AB LNC-RU-RU (LOINC Linguistic Variant - Russian, Russia) 2015AB LNC-TR-TR (LOINC Linguistic Variant - Turkish, Turkey) 2015AB LNC-ZH-CN (LOINC Linguistic Variant - Chinese, China) 2015AB MCM (Glossary of Clinical Epidemiologic [doctor.am]
[…] epididymitis will eventually "burn out" of patient's system if left untreated, though this might take years or even decades.  However, some prostate -related medications have proven effective in treating chronic epididymitis, including doxazosin.  Epidemiology [en.wikipedia.org]
Miller, Anaphylaxis in the United States: an investigation into its epidemiology. Arch Intern Med, 2001. 161(1): p. 15-21. 28. Brady, M.T., Cellulitis of the penis and scrotum due to group B streptococcus. J Urol, 1987. 137(4): p. 736-7. 29. [ispub.com]
Materials and Methods: A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management. [ncbi.nlm.nih.gov]
Sandlow, Varicocele: current concepts in pathophysiology, diagnosis, and treatment. Urol Clin North Am, 2002. 29(4): p. 921-37. 10. Dreyer, G., et al., Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. [ispub.com]
Patients are given broad-spectrum antibiotics to prevent infection. Surgeons often leave the wound open until it heals. This requires proper wound care to prevent infection. [docdoc.com.sg]
The scrotal wound is left open and packed to prevent reoccurrence of the abscess. [emedicine.medscape.com]
Other prevention methods are as follows: abstinence (no sexual relations); condom use (reduces chances for infection by about 90%); monogamy with only one uninfected sex partner; preventing child abuse in pediatric patients; and mumps vaccination. [emedicinehealth.com]
Joseph MG, O'Boyle PJ: The 'hitch-stitch' and drain technique for the prevention of inguinoscrotal haematoma following complicated inguinoscrotal surgery. J R Coll Surg Edinb 1989, 34:104-105. [igmpublication.org]
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- Huen KH, Nourparvar P, DeCaro JJ, Walsh MD, Issa MM, Ritenour CWM. Scrotal Abscess as Initial Presentation of Squamous Cell Carcinoma. Case Rep Urol. 2013;2013:807346.
- Horstman WG, Middleton WD, Melson GL, Siegel BA. Color Doppler US of the scrotum. Radiographics. 1991;11(6):941-957; discussion 958.