Right paratesticular abscess mimicking neonatal testicular torsion and caused by Proteus mirabilis

Ezomike, Uchechukwu Obiora; Ituen, MA; Ekpemo, Samuel Chidi; Ekenze, Sebastian Okwuchukwu

doi:10.1016/j.afju.2013.03.004

Cited by 2 publications

(6 citation statements)

References 8 publications

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“…However, as previously reported in some cases of neonatal pyo-cele, US imaging can be misleading. Infantile pyocele and a scrotal abscess can mimic the Doppler sonographic findings in missed testicular torsion (6,10,11). In our patient the testicle looked viable, homogenous, and normal Doppler flow within the testicle was visible.…”

Section: Discussionsupporting

confidence: 53%

“…The main pathogens described in pyocele are Echerichia coli and Staphylococcus spp., but Klebsiella pneumoniae and other coliforms, β-hemolytic streptococci, Salmonella spp, Bacteroides fragilis and Proteus mirabilis have also been reported as etiological agents. Nonetheless, the majority of cases of pyocele are idiopathic in aetiology and the source of infection remains unrecognized (1,(3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

“…It typically manifests with fever, tenderness of the scrotum or inguinal canal, erythema and sometimes scrotal discol-oration (1)(2)(3)(4). Since 1975 only a few cases of neonatal pyocele have been described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Herein, we present a case of a septic ten-dayold neonate admitted to the Department of neonatology with an acute scrotum; postnatal testicular torsion with non-viable testicle, testicular malignancy or severe epididymoorchitis were suspected but the condition turned out to be a pyocele, caused by Streptococcus pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

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Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Lozej¹,

Paro–Panjan

Thaler

et al. 2019

CEJoP

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Objective -Bacterial infection of the scrotal appendages (scrotal pyocele) is a rare condition, especially in neonates. It is easy to confuse with other scrotal emergencies that require surgical intervention and orchiectomy. We present a case where pre-and intraoperative diagnosis was not clear and orchiectomy was performed; additionally, review of the literature, diagnostics, treatment options and lessons learned are discussed. Case report -A ten-day old full term neonate, born with bilateral hydroceles and glandular hypospadias, presented with a six day history of poor feeding and irritability; clinical examination revealed an enlarged, erythematous and tender right hemiscotum. Blood cultures, routine laboratory examinations and ultrasound (US) imaging was performed. Postnatal torsion with non-viable testicle, testicular malignancy and epididymo-orchitis were considered in the differential diagnosis. Upon surgical exploration, the testicle appeared non-viable due to severe inflammation and was removed. The patient was treated initially with ampicillin and gentamicin. After Streptococcus pneumoniae was cultured from specimens, treatment was continued with benzyl penicillin. Conclusion -Neonatal scrotal pyocele is an extremely rare condition. The main suggestive features are clinical presentation with signs of infection and an enlarged painful scrotum. US is the investigation of choice to differentiate from a surgical emergency. Free fluid in the scrotal cavity with septae, normal looking testicle on US and no signs of torsion at exploration are diagnostic signs. If diagnosed early, the first line of management is surgical aspiration or decompression, followed by broad-spectrum antibiotic treatment. With delay in diagnosis, the testicle may look non-viable and push surgeons for orchiectomy.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Lozej¹,

Paro–Panjan

Thaler

et al. 2019

CEJoP

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“…[ 11 ] Clinical, radiological, operative findings, and histology may all not be to differentiate between the above two causes, in cases of severe scrotal abscess and both usually ends up in orchiectomy. [ 12 ] Omphalitis or necrotizing enterocolitis and hematogenous spread might have caused an abscess in abdomen and scrotum. Treatment modalities of epididymorchitis are early diagnosis with antibiotic, drainage/aspiration, and rarely gonad excision.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment modalities of epididymorchitis are early diagnosis with antibiotic, drainage/aspiration, and rarely gonad excision. [ 12 ] Idiopathic pyocele can be treated with needle aspiration and antibiotic.…”

Section: Discussionmentioning

confidence: 99%

Scrotal abscess: Varied etiology, associations, and management

Ramareddy

Alladi

2016

J Indian Assoc Pediatr Surg

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Aim:To report a series of scrotal abscess, a rare problem, their etiology, and management.Materials and Methods:A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management.Results:Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) [1]; three anorectal malformations with ectopic ureter [1], urethral stricture [1], and neurogenic bladder [1]; meconium peritonitis with meconium periorchitis [2], ileal atresia [1], and intra-abdominal abscess [1]; posturethroplasty for Y urethral duplication with metal stenosis [1] and idiopathic pyocele [1]. Transmission of the organism had varied routes include fallopian tube [1], urethra ejaculatory reflux [4], hematogenous [2], and the patent process of vaginalis [2]. Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics.Conclusion:Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter.

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Right paratesticular abscess mimicking neonatal testicular torsion and caused by Proteus mirabilis

Cited by 2 publications

References 8 publications

Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Scrotal abscess: Varied etiology, associations, and management

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