Unusual cause of a painful right testicle in a 16-year-old man: a case report.
BACKGROUND
Urgent surgical exploration of the scrotum of a child or teenager who presents with a painful and swollen testicle is paramount if testicular torsion is not to be missed. It is extremely rare for a non-scrotal pathology to present with acute scrotal signs. Here we present such a rare case and emphasize the importance of being aware of this potential clinical pitfall.


METHODS
A 16-year-old Caucasian man presented as a surgical emergency with a five to six hour history of a painful, red, and swollen right hemiscrotum. He also complained of vague lower abdominal pain, vomiting, and watery diarrhea. He had a temperature of 38.5°C and a tender, red, and swollen right hemiscrotum. The right testicle appeared elevated. He was mildly tender in his central and upper abdomen and less so in the lower abdomen. No convincing localizing abdominal signs were noted. He had an increased white cell count (15 × 109/L) and C-reactive protein (CRP; 300 mg/L). Urgent right hemiscrotal exploration revealed about 5 ml of pus in the tunica vaginalis and a normal testicle. A right iliac fossa incision identified the cause: a perforated retrocecal appendix. Appendectomy was performed, and both the abdomen and scrotum washed copiously with saline before closure. The patient made an uneventful recovery.


CONCLUSIONS
Acute appendicitis presenting with scrotal signs due to a patent processus vaginalis is an extremely rare clinical entity. To date, fewer than five such cases have been reported in the medical literature. It is, therefore, extremely important to be aware of this unusual clinical scenario, as only a high index of suspicion will enable prompt, successful management of both the appendicitis and the scrotal abscess.
Department of Surgery, Watford General Hospital, Vicarage Road, Watford, West Hertfordshire WD18 0HB, UK. khalidshehzad@hotmail.com.
Khalid N
KN
Shehzad
Amjid A
AA
Riaz
Pediatr Surg Int. 2001 Sep;17(7):569-71
11666064
South Med J. 1994 Jan;87(1):23-5
8284712
Int Urol Nephrol. 2006;38(3-4):663-5
17160451
Cases J. 2008 Sep 19;1(1):165
18803815
Br J Radiol. 2000 Jul;73(871):780-2
11089472
Int J Urol. 1998 Jan;5(1):108-10
9535614
Afr J Paediatr Surg. 2009 Jul-Dec;6(2):116-7
19661645
J Pediatr Surg. 1994 Dec;29(12):1622
7877054
J Perinatol. 1999 Oct-Nov;19(7):536-7
10685308
Singapore Med J. 2002 Jul;43(7):365-6
12437045