Inguinoscrotal extension of a pancreatic collection: a rare complication of pancreatitis—case report and review of the literature

Abstract

Pancreatitis associated with the extension of a pancreatic collection, pseudocyst or abscess into the groin is a rare phenomenon with few reports in the English literature. Nevertheless, it remains a clinically important differential diagnosis as it may be mistaken for more common pathologies in the groin and with a subsequent unnecessary surgical intervention. A case of this rare complication of pancreatitis is reported, together with a review of the literature.

Hydrocele in recurrent acute pancreatitis caused by testicular venous obstruction

“…Pancreatic hydrocele is a rare complication of acute pancreatitis with 34 cases reported in the literature. [ 5 – 14 ] Previous studies proposed that hydrocele is resulted from peripancreatic fluid in the retroperitoneum tracking through pelvic space, inguinal canal into the scrotum along processus vaginalis. [ 5 – 14 ] Those patients had failure of closure of the processus vaginalis.…”

“…[ 5 – 14 ] Previous studies proposed that hydrocele is resulted from peripancreatic fluid in the retroperitoneum tracking through pelvic space, inguinal canal into the scrotum along processus vaginalis. [ 5 – 14 ] Those patients had failure of closure of the processus vaginalis. Consequently, the fluid dissected between the visceral and parietal layers of the tunica vaginalis led to communicating hydrocele.…”

“…[ 31 , 32 ] Pancreatic hydrocele usually subsides spontaneously once pancreatitis resolves under conservative treatment. [ 5 , 11 , 19 , 23 ] However, hydrocele may attribute to congestive varicose vein of testis that increases the risk of male infertility, so treating varicose vein is mandatory for severe cases. [ 33 , 34 ] Although the image demonstrates pancreatic inflammation around right testicular vein, true relationship between pancreatic hydrocele and occlusion of testicular venous flow remains unclear.…”

Contents of the inguinal canal: identification by different imaging methods

“…Many conditions, such as incarcerated hernia, Amyand's hernia, and diverticulitis, can lead to the formation of an abscess in the inguinal canal. Pancreatitis accompanied by a fluid collection, pseudocyst, or abscess extending to the inguinoscrotal region, as shown in Figures 14 and 15, is rare (7) .…”

Unilateral Scrotal Swelling After Acute Pancreatitis of Pancreas Transplant Graft

“…In addition, this case may be the first of AGP with scrotal involvement, with few cases reported in patients with nontransplant acute pancreatitis. 3 In nontransplant patients, scrotal involvement involves dissection of peripancreatic collections along anatomic planes from the retroperitoneum to the inguinal canal. In the setting of AGP, the direct path to the inguinal canal may differ given the intra-abdominal location of the graft, which is typically placed in the right iliac fossa, sustained by arterial supply from the common iliac artery and venous drainage by the common iliac vein or inferior vena cava (80%) or portal vein, with pancreatic duct drainage by either the bowel (80%) or bladder.…”