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].

• Pathologist

  Although we can often differentiate them by their location, appearance, and rate of growth, we may sometimes recommend excision and further microscopic examination by a trained pathologist. [deltamedix.com]

• Rebound Tenderness of the Right Lower Quadrant

  Abdominal examination revealed tenderness and rebound tenderness in the right lower quadrant of the abdomen. Temperature was 37.9 C and leucocytosis was 16,000 mm3, with left shift. [casesjournal.biomedcentral.com]

• Unilateral Blindness

  blind ending hydro ureter in males may be reflexing/obstructive, or both. [ncbi.nlm.nih.gov]

• 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 pathology often reflects intra-abdominal disease.[4,11] Necrotizing epididymorchitis and neglected perinatal torsion of testis may both result in a scrotal abscess.[11] Clinical, radiological, operative findings, and histology may all not be to [ncbi.nlm.nih.gov]

• 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]

  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]

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.

• Treponema Pallidum

  It is a chronic bacterial infection, caused by the sexually transmitted spirochete, Treponema pallidum. Though it has drastically reduced in prevalence, its recent resurgence (especially with HIV disease) is worrying. [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]

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.