Scrotal abscess after a perforated appendicitis

Abstract

Although perforated appendicitis in pediatric patients can result in a diverse array of complications, scrotal abscess is a rarely documented phenomenon. We present a case of acute scrotum after laparoscopic appendectomy. A retrospective review of prior literature on scrotal abscess secondary to perforated appendicitis was performed via PubMed to review the clinical presentation, etiology, type of treatment and outcome of pediatric patients. Patients without a patent processus vaginalis still require vigilant follow-up postoperatively to ensure timely intervention if scrotal pain develops during recovery.

Scrotal Pyocele Secondary to Perforated Appendicitis in Middle-Aged Man: A Case Report and Review of Literature

“…It has been seen mostly in patients with patent processus vaginalis, and mainly seen in the pediatric age group. Two published articles have reviewed the previously reported cases in children and adolescents [ 3 , 4 ]. There were a very limited number of cases reported among young adults, and our case report is the first one directed at the adult age group.…”

“…Passage of fluids through grossly non-patent processus vaginalis has been explained by many authors. This can be attributed to the microscopically permeable processus vaginalis in those with grossly non-patent processus vaginalis and some authors relate that to the presence of micro-perforations in the processus vaginalis that allow purulent material to pass into the inguinal region and scrotum [ 3 ]. Other authors have attributed that to the presence of an undiagnosed congenital inguinal hernia [ 7 ].…”

“…Cases that occur post-laparoscopic appendectomy have been attributed by some authors to the translocation of intra-abdominal bacteria through the closed processus vaginalis due to the higher insufflation pressure needed during laparoscopy [ 3 ]. Others have reported the occurrence of hydrocele post-laparoscopic cholecystectomy and have attributed the reopening of the obliterated processus vaginalis to high intra-abdominal pressure [ 13 ].…”

Hypoxic respiratory failure in acute appendicitis: A bronchoperitoneal fistula as the presenting symptom of appendicitis in the setting of pediatric COVID-19

“…The most common complication of acute appendicitis is perforation, and the rate of perforated appendicitis decreases with age starting as high as 83% in neonates [ 4 ] and decreasing to 11 to 32% in children aged 5 to 12 [ 5 ]. Atypical presentations of appendicitis include appendicitis occurring in inguinal [ 6 ] and femoral [ 7 ] hernias, intussusception of the appendix [ 8 ], and appendicitis causing scrotal abscesses [ 9 ]. Rarer still is the development of a bronchoperitoneal fistula after perforated appendicitis.…”

Scrotal Abscess Complicating Appendicular Perforation Peritonitis

“…The peritoneal contents, especially pus, trickle down and migrate into the scrotum through PPV. [ 1 , 2 ] PPV is seen in 90% of the newborns and gradually declines to 20% in the adults. [ 1 , 2 ] Scrotal abscess may present concurrently with complicated appendicitis or may be encountered after 1–10 days of appendectomy (open/laparoscopy).…”