Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis

Abstract

Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT) scan of the abdomen showed acute pancreatitis. The patient's condition deteriorated and he was admitted to the intensive care unit (ICU). After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US) of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

Penoscrotal Edema as a Rare Complication of Acute Pancreatitis: A Case Report

“…In most cases (n = 11), pancreatitis was alcohol induced, 14 cases had interstitial edematous acute pancreatitis, and 4 cases of necrotizing pancreatitis. By searching the PubMed database, 26 cases of swelling of the penoscrotal and inguinal region in patients with acute pancreatitis have been published [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Previous studies proposed that hydrocele is a result of peripancreatic fluid in the retroperitoneum tracking through pelvic space and inguinal canal into the scrotum along processus vaginalis [7][8][9]15].…”

“…However, scrotal swelling or hydrocele is a rare presentation of acute pancreatitis described in the literature so far [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. According to previous study, 57% of patients with acute pancreatitis were diagnosed to have fluid collections, 39% having two and 33% having three or more areas involved [16].…”

Pancreatitis ritka scrotalis érintettsége - A korai differenciáldiagnosztika fontossága = Rare Scrotal Manifestation of Pancreatitis – The Role of Early Differential Diagnostics

“…Az akut scrotum egy urológiai sürgősségi állapot, aminek a hátterében állhat a here és függelékeinek csavarodása, trauma, orchido-epididymitis, heretályog, illetve kizáródott lágyéksérv is. A felsorolt esetek alapján elmondható, hogy a scrotalis duzzanat ritkán pancreatitis szövődményeként is kialakulhat, a retroperitoneumból induló, az inguinalis csatornán a herezacskót elérő gyulladásos eredetű tályog eredményeként (10,13). Esetünkben a gondos preoperatív differenciáldiagnosztika tette lehetővé a szervkímélést, elkerülve a here feltárását, ami az elhúzódó sebgyógyulás miatt kedvezőtlenül befolyásolhatja a beteg életminőségét.…”

Pancreatitis Gone Nuts: Scrotal Hydrocele as a Complication of Severe Acute Pancreatitis

“…Scrotal involvement in acute pancreatitis can also be confused with testicular torsion and other potential medical emergencies including epididymitis and incarcerated ventral/inguinal hernia, so it is generally recommended that patients be imaged quickly to determine if prompt surgical exploration is necessary [4]. Conservative management without surgery may be possible if there is no sign of testicular compromise [5].…”