title: Inguinoscrotal region as an unusual site of extra-pancreatic collections in infected pancreatic necrosis.
abstract: Severe acute pancreatitis often leads to pancreatic and peripancreatic collections but, rarely, it can lead to collections at sites remote from the pancreas. Three male patients presented with abdominal pain and inguinoscrotal swelling. They were initially misdiagnosed with obstructed inguinal hernia, epididymo-orchitis and hydrocele, respectively. Later, their diagnosis of acute pancreatitis was revealed on laparotomy in one patient and on computed tomography (CT) in the remaining two patients. All these cases had extensive peripancreatic necrosis and paracolic collections tracking along the psoas muscle, downwards towards the pelvis. These collections were initially managed by percutaneous drainage and saline irrigation as a part of the 'step-up' approach. Two of these patients required open necrosectomy, while all required incision and drainage of inguinoscrotal collections. All the patients were discharged in satisfactory condition. Inguinoscrotal swelling is unusual as a first presentation of acute pancreatitis. A high index of suspicion, with careful study of patient's history and examination along with CT, may provide an accurate diagnosis. Local drainage may be required to control sepsis and also provide an egress route for intra-abdominal collections.
authors: Surgical Gastroenterology Division, Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Saurabh
authors: S
authors: Kalia
authors: Surgical Gastroenterology Division, Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Rahul
authors: R
authors: Gupta
authors: Surgical Gastroenterology Division, Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Sunil D
authors: SD
authors: Shenvi
authors: Surgical Gastroenterology Division, Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Hemanth
authors: H
authors: Kumar
authors: Surgical Gastroenterology Division, Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India rajsarakshi@yahoo.co.in.
authors: Rajesh
authors: R
authors: Gupta
authors: Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Mandeep
authors: M
authors: Kang
authors: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Surinder Singh
authors: SS
authors: Rana
authors: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Deepak Kumar
authors: DK
authors: Bhasin
authors: Surgical Gastroenterology Division, Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: Rajinder
authors: R
authors: Singh
keywords: acute pancreatitis; inguinoscrotal collections; necrosectomy; step-up approach
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