Case Study - March 2012

A 53 year old man presented to A+E with a 2 week history of testicular swelling. He had complained of left inguinal swelling and pain 2 weeks prior and was admitted with a suspected incarcerated inguinal hernia. He was subsequently discharged on antibiotics. The swelling in his left groin disappeared but was replaced by gross testicular swelling and pain. His past medical history includes hypothyroidism and dilated cardiomyopathy. He was haemodynamically normal on admission with no fever. His inflammatory markers revealed a high WCC and a CRP>250. He went on to having a CT.

What does the CT show?

What are the possible causes?

What would you do next?

.What would the definitive management be?

Reveal Answer

What does the CT show?
This is a CT scan with IV contrast demonstrating an air/fluid level in the scrotum. There is some inflammatory stranding but no air in the scrotal wall.

What are the possible causes?
Given the CT appearances and the clinical history, the differentials for this appearance are an inguinoscrotal hernia or a scrotal abscess.

What would you do next?
The patient needs treatment according to the ABC protocol. After stabilising, they need IV fluid, high dose IV antibiotics including anaerobe cover (IV Tazocin and Vancomycin in this case), fasting for surgery and review by plastics with a view to the potential need for tissue grafting.

What would the definitive management be?
The patient underwent incision and drainage of his scrotum. Initially pus was removed and sent for microbiology. The area was widely debrided to bleeding tissue and the wound left open over a corrugated drain. Having had 48 hours antibiotics, primary closure was successful over a drain.

The cookie setting on this website is set to ‘allow cookies’ to give you the very best experience.

If you continue without changing this setting, you consent to this - but if you want, you can change your setting at any time using the ‘change cookie setting’ link at the bottom of this page.

Cookie Setting

Our Cookies

Cookie NamePurpose
eu_ask This is used to store the cookie setting you set in the form above.
If you choose 'Do Not Allow Cookies' we will need to store this information as a cookie with the value N.
If you choose 'Allow Cookies' or do not make a choice, we will store this information as a cookie with the value Y.

The value is kept for one year.

3rd Party Cookies

Cookie NamePurpose
Google Analytics This website uses Google Analytics, a web analytics service provided by Google, Inc.
Google Analytics sets a cookie in order to evaluate your use of the website and compile reports for us on activity on the website.
Google stores the information collected by the cookie on servers in the United States.
Google may also transfer this information to third parties where required to do so by law,
or where such third parties process the information on Google's behalf.
Google will not associate your IP address with any other data held by Google
By using this website, you consent to the processing of data about you by Google in the manner and for the purposes set out above.

How to reject or delete this cookie