Scrotal Swelling After An Episode Of Acute Pancreatitis

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(a) Computed tomography scan showing inflammation near the pancreatic head compressing the stomach and duodenum (left), and marked edema of the right inguinal canal and hemiscrotum with inflammatory peripancreatic fluid visibly tracking down into the pelvis (arrows at center and right).

A 33-year-old man develops scrotal swelling one week after acute pancreatitis!

A 33-year-old male presented to the emergency department and get a diagnosis of acute gallstone pancreatitis. Pancreatic fluid collection complicated his recovery. The patient complained of swelling and intense right-sided scrotal pain within a week of his hospital stay.

His physicians performed a computed tomography scan which showed inflammatory stranding near the pancreatic head, which was compressing the stomach and duodenum. Moreover, a new, marked edema of the right inguinal canal and hemiscrotum with inflammatory peripancreatic fluid tracking down into the pelvis was visible.

Clinically evident and significant inguinoscrotal swelling from a pancreatic hydrocele after an episode of acute pancreatitis is a rare complication.

Management:

Urologists decided to perform immediate scrotal exploration. Intraoperatively, they observed several hundred milliliters of cloudy, lipase-rich fluid from the right hydrocele sac. The findings confirmed that the inguinoscrotal inflammatory fluid was of pancreatic origin. Additionally, the right testicle appeared viable and preserved. There were no signs of infection or necrosis of the right testicle. The surgeons achieved local percutaneous drainage intra-operatively by placing two small caliber drains into the right scrotum. The purpose of the drain placement was to ensure complete resolution.

 After 7 days, since the output stopped, the drains were removed.

The patient had persistent complaints of anorexia and abdominal pain, therefore, he required endoscopic transluminal drainage for the evolving pancreatic head fluid collection.

Although it is a case of a rare complication, it is imperative to be aware of the rare complications. Awareness is important to be able to make a prompt diagnosis and provide adequate treatment. Moreover, it is equally vital to be able to differentiate the cause as scrotal swelling secondary to pancreatic fluid accumulation may mimic testicular torsion, epididymitis, and incarcerated ventral/inguinal hernia. Therefore, physicians should perform immediate imaging to rule out potential emergencies. And to decide whether the patient requires an urgent surgical exploration or not.

References:

Gaffney RR, Moyer MT (2016) Pancreatitis Gone Nuts: Scrotal Hydrocele as a Complication of Severe Acute Pancreatitis. Clin Med Img Lib 2:042. doi.org/10.23937/2474-3682/1510042

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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