Meconium-induced periorchitis

Abstract

A testicular tumour-like lesion or a solid extratesticular mass are serious postnatal problems with a broad spectrum of inflammatory or tumorous causes and possible differential diagnoses. In this case report, an extraordinary case of a newborn boy with a rare cause of a periorchitis is described.A premature boy infant (25-year-old mother with obesity) was diagnosed as having a disturbance of prosperity. A plain film of the abdomen showed a dilated intestine (no pathological findings in abdominal ultrasound, in particular, no ascites). After 3 postnatal months of clinical observation at the hospital including temporary parenteral nutrition, hydrocele at both sides was diagnosed. Therefore, the boy underwent surgical exploration. Intraoperatively, the processus vaginalis peritonei was surprisingly filled with meconium; because of that, the situs was extensively rinsed. In addition, the boy underwent an operation for the right and left hydrocele. The testes were preserved (on follow-up investigation there were no further problems).Pathohistological investigation confirmed meconium periorchitis, which is a rare postnatal disease and which can only develop in cases of former meconium peritonitis and if the processus vaginalis peritonei is open. The precise details of cause and pathophysiology in this case may significantly help in avoiding unnecessary orchiectomy.

Sonography of Meconium Periorchitis in the Neonate

“…The resulting spillage of fetal meconium into the peritoneal cavity results in meconium peritonitis which occurs with a frequency of 1 in 35,000 births. [1] In addition, meconium peritonitis can be seen in 15% of infants with CF. [2] Commonly, the bowel perforation will spontaneously seal off resulting in an intact bowel at birth but the resulting spilled peritoneal meconium causes an inflammatory response, which can subsequently manifest as scattered peritoneal abdominal calcifications that are typically of no clinical significance.…”

“…[4,6] However, as in our case, some scattered color Doppler flow has been reported within the meconium hydrocele, likely from localized scrotal inflammatory response. [1,7] Once the meconium hardens overtime, it may appear as multiple hyperechoic masses adjacent to the testicle with scattered shadowing calcifications. [5] Any accompanying clinical or sonographic findings consistent with meconium ileus, peritonitis, intestinal atresia (such as fetal echogenic bowel and polyhydramnios), dilated bowel loops, ascites, or pseudocyst may also help to clarify the diagnosis of meconium periorchitis.…”