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

Abstract

A scrotal abscess following perforated appendicitis is a rare complication. This is mostly seen in children and usually occurs due to the presence of the patent processus vaginalis, which permits the passage of pus from the intra-abdominal cavity down to the scrotum, resulting in a scrotal pyocele. There are few reported cases of such complications in young adult patients. We report a case of a 50-year-old male with a scrotal pyocele following exploratory laparotomy for perforated appendicitis. Scrotal ultrasound (US) findings were suggestive of a right-sided scrotal abscess, and the CT scan showed prominent fat in the proximal part of the right inguinal canal, which suggested the presence of a partially patent processus vaginalis. Our case is the first reported in the middle-aged group, and our review of the literature is the first directed to the adult age group. This review emphasizes the importance of considering scrotal pyocele in any patient with acute scrotum post-appendectomy, regardless of the patient's age, the affected side, and the presence or absence of identifiable patent processus vaginalis, as it may be microscopically permeable. Treatment will entail urgent drainage of the abscess, together with a course of antibiotics.