Scrotal abscess is an infection of the testicleals. It can present in any age group and a few cases have been reported even in the neonatal age group. The most common cause is postneglected testicular torsion (the spermatic cord twists, cutting off the testicle's blood supply) or necrotizing epididymoorchitis (an inflammation of the epididymis and/or testicle (testis)). Other causes include infection of the hydrocele or tuberculous infection. Most patients who develop acute scrotal signs due to appendicular pathology have a PPV (patent processus vaginalis). Less than one-third of these patients have a clinical hernia before presentation.
The presentation is usually of severe scrotal pain, redness, heat, tenderness and systemic toxicity including fever and leukocytosis (white cells above the normal range in the blood). Patient may or may not have vomiting. At times, lower abdominal pain is present but this is attributed to the scrotal pathology rather than as a cause of the scrotal abscess. Clinical examination is not very helpful because of the tenderness. Ultrasound examination usually reveals mild fluid with internal echoes or a hypoechoic lesion with normal or swollen scrotal contents. As the most important differential is torsion of either the testis or one of its appendages, a surgical exploration is almost always needed.
Usually upon exploration, turbid fluid is encountered. If the fluid recollects after mopping and no local pathology is detected, this should raise the suspicion of an intra-abdominal cause. Sometimes the tip or the entire appendix may be seen in the sac. Usually, a PPV is found. An abdominal exploration may show an acute appendicitis (inflammation of the appendix), a perforated appendix or a retroperitoneal abscess (a collection of pus in retroperitoneal space). Although mostly this disease occurs on the right side, left-sided acute scrotum has also been reported due to appendicular pathology. Sometimes the diagnosis is missed and recognized later because of the continuing toxicity. Drainage of pus, appendectomy (the surgical removal of the appendix) and closure of the PPV during the same sitting offers satisfactory results.