Edit concept Question Editor Create issue ticket

Scrotal Abscess

Scrotum Abscess

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.


Presentation

Scrotal abscess is considered to be a rare phenomenon in general practice [1] [2] [3]. 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. [1] [2] [3] [4] [5]. 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 [1] [2] [4]. 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 [2] [3]. 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 [2]. In some patients, lower abdominal pain, fever, and vomiting may be present [2].

Photosensitivity
  • Major adverse events include skin rash, photosensitivity, pruritus, cutaneous squamous-cell carcinoma or keratoacanthoma.[ncbi.nlm.nih.gov]
Neglect
  • Undiagnosed or neglected testicular torsion is another important diagnosis that predisposes the pediatric population to the development of scrotal abscess.[symptoma.com]
Scrotal Pain
  • Patients without a patent processus vaginalis or inguinal hernia at initial presentation of peritonitis must be carefully followed in the postoperative period and explored early if testicular or scrotal pain becomes manifest.[ncbi.nlm.nih.gov]
  • 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.[symptoma.com]
  • If you have scrotal pain or urinary symptoms and cannot be seen by your health care provider (or if you do not have one), then you should go to a hospital’s emergency department.[justanswer.com]
  • Ultrasound Evaluation of Acute Scrotal Pain (Matthew T. Heller, MD) Click here to take the quiz.[iame.com]

Workup

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 [2].

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) [6], laboratory and imaging studies need to be employed. Laboratory tests can reveal leukocytosis and elevated inflammatory parameters [2]. Ultrasonography is the gold-standard for assessing scrotal pathologies and should be performed in all patients [1] [7]. Typical characteristics of scrotal abscess include fluid collection with a hypervascular margin and irregular walls [1] [5] [7]. In the case of an infection, the underlying cause should be investigated through microbiological methods.

Entamoeba Histolytica
  • The invasive form of Entamoeba histolytica trophozoite was seen in Giemsa stained aspirate of the abscess. In case of an abscess bacteria are primarly considered, but the case presented here shows that amoeba can be the cause, although very rarely.[ncbi.nlm.nih.gov]
Pancreatic Necrosis
  • In severe pancreatitis, necrosis of pancreas and surrounding tissues may occur. Acute necrotizing pancreatitis commonly presents as pancreatic abscess occasionally with systemic complications.[ncbi.nlm.nih.gov]

Treatment

  • OBSERVATION: 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]
  • 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]
  • 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]
  • 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]

Prognosis

  • 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]
  • Treatment and prognosis Management may include prolonged antibiotics, surgical debridement or even orchidectomy 1,4 .[radiopaedia.org]
  • 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]
  • […] tissue oxygenation is controversial due to the high cost, low availability and the limited body of evidence supporting it’s use.[34] When available this treatment should be initiated in patients with extensive disease and/or immunocompromise because prognosis[ispub.com]

Etiology

  • 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]
  • The etiology of superficial scrotal abscess is infected hair follicles and infections of scrotal lacerations or minor scrotal surgeries.[emedicine.medscape.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]

Epidemiology

  • 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. [5] However, some prostate -related medications have proven effective in treating chronic epididymitis, including doxazosin . [14] 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • The scrotal wound is left open and packed to prevent reoccurrence of the abscess.[emedicine.medscape.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]
  • Dietrich 1 doctor agreed: No: The bartholin's duct cyst--abcess sometiimes can be opened and drained, but many times, to prevent it from returning the gland is surgically removed completely under anesthesia . ...Read more See 1 more doctor answer Dr.[healthtap.com]
  • Prevention For men younger than 35 years, the cause is usually sexually related diseases. If one partner is infected, the other partner should be evaluated and potentially treated as well.[justanswer.com]
  • If a cyst, we try to remove the entire capsule in order to prevent its recurrence. Simple drainage of a cyst may not be effective because the capsule may refill. The specimen will be sent to the pathologist for analysis.[deltamedix.com]

References

Article

  1. Ramareddy RS, Alladi A. Scrotal abscess: Varied etiology, associations, and management. J Indian Assoc Pediatr Surg. 2016;21(4):164-168.
  2. Mansoor K, Samujh R, AlAlayet YF. Scrotal abscess with a rare cause. J Indian Assoc Pediatr Surg. 2009;14(3):119-120.
  3. Lee YC, Wu WJ, Huang SP, Tsai HN, Chou YH, Huang CH. Scrotal abscess originating from appendicitis: a case report. Kaohsiung J Med Sci. 2003;19(5):242-245.
  4. Dogra VS, Gottlieb RH, Rubens DJ, Liao L. Benign intratesticular cystic lesions: US features. Radiographics. 2001;21:S273-281.
  5. Yusuf GT, Sidhu PS. A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 2013;16(4):171-178.
  6. 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.
  7. Horstman WG, Middleton WD, Melson GL, Siegel BA. Color Doppler US of the scrotum. Radiographics. 1991;11(6):941-957; discussion 958.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 08:52