Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2012  |  Volume : 5  |  Issue : 2  |  Page : 206
Scrotal pyocele: Uncommon urologic emergency


Emergency Medicine Department, Naval Medical Center Portsmouth, VA, USA

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Date of Web Publication24-May-2012
 

How to cite this article:
Bruner DI, Ventura EL, Devlin JJ. Scrotal pyocele: Uncommon urologic emergency. J Emerg Trauma Shock 2012;5:206

How to cite this URL:
Bruner DI, Ventura EL, Devlin JJ. Scrotal pyocele: Uncommon urologic emergency. J Emerg Trauma Shock [serial online] 2012 [cited 2019 Dec 15];5:206. Available from: http://www.onlinejets.org/text.asp?2012/5/2/206/96504


Sir,

A scrotal pyocele is a rarely described urologic emergency that must be recognized and treated quickly to prevent testicular damage or Fournier's gangrene. We present a 74 year-old man with four days of left-sided scrotal pain and swelling. Physical examination revealed edema, erythema, and tenderness on the left side of the scrotum extending onto his penis proximally. A scrotal ultrasound was obtained [Figure 1] demonstrating a large scrotal pyocele. Urology surgically drained the pyocele without performing an orchiectomy.
Figure 1: Scrotal ultrasound showing a normal appearing testicle with a scrotal free fluid with newly developed septations and echogenic debris and thickened scrotal skin without evidence of free air within the scrotal wall

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Scrotal pyoceles are purulent collections within the potential space between the visceral and parietal tunica vaginalis surrounding the testicle. [1] They are commonly associated with acute epididymo-orchitis. [1] The presentation of scrotal pyoceles is subacute onset of pain and swelling, which may mimic other pathology. The imaging modality of choice to diagnose a scrotal pyocele is ultrasound. [2] Internal echoes within the pyocele fluid collection typically represent cellular debris. Other sonographic findings include loculations, septae, and fluid-fluid or air-fluid levels in the tunica vaginalis external to the testicle. [3] By contrast, a hydrocele will appear on ultrasound as a simple fluid with an anechoic region that collects anterior and lateral to the testis. If the fluid contains internal echoes on ultrasound, the diagnosis of hematocele (most common in the setting of trauma) or pyocele may be made. [3],[4] Fournier's gangrene is the most concerning complication of a scrotal pyocele. If there are concerns for Fournier's, computed tomography is recommended to delineate the extent of disease and facilitate surgical planning. [5] Early diagnosis using ultrasound, therefore, will help prevent the development of sepsis and preserve a functional outcome. [2],[6] Treatment requires broad spectrum antibiotics and surgical drainage. Many patients, however, ultimately require orchiectomy. [1],[6]


   Acknowledgment Top


The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.

 
   References Top

1.Slavis SA, Kollin J, Miller JB. Pyocele of the scrotum: Consequence of spontaneous rupture of testicular abscess. Urology 1989;33:313-6.  Back to cited text no. 1
[PUBMED]    
2.Rizvi SA, Ahmad I, Siddiqui MA, Zaheer S, Ahmad K. Role of Color Doppler Ultrasonography in Evaluation of Scrotal Swellings: Patter of disease in 120 patients with review of the literature. Urol J 2011;8:60-5.  Back to cited text no. 2
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3.Ragheb D, Higgins JL. Ultrasonography of the scrotum: Techniques, anatomy, and pathologic entities. J Ultrasound Med 2002;21:171-85.  Back to cited text no. 3
    
4.Akin E, Khati NJ, Hill MC. Ultrasound of the scrotum. Ultrasound Q 2004;20:181-200.  Back to cited text no. 4
    
5.Lee C, Henderson SO. Emergency surgical complications of genitourinary infections. Emerg Med Clin N Am 2003;21:1057-74.  Back to cited text no. 5
    
6.Butler JM, Chambers J. An unusual complication of epididymo-orchitis: Scrotal pyocele extending into the inguinal canal mimicking a strangulated inguinal hernia. J Emerg Med 2008;35:379-84.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
David I Bruner
Emergency Medicine Department, Naval Medical Center Portsmouth, VA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.96504

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