title: Emphysematous epididymo-orchitis as a camouflage of prostate invasion secondary to rectum cancer: A case report.
abstract: BACKGROUND
  Emphysematous epididymo-orchitis is a rare cause of acute scrotum pain characterized by gas formation within the tissue. Diabetes mellitus and recto-seminal fistula secondary to sigmoid diverticulitis are generally accepted as being responsible for this disease. However, prostate invasion secondary to rectal cancer may be considered to be a newly identified pathogenetic mechanism. Herein, we report this rare case and illustrate the pathogenesis.
  
  
  METHODS
  A 69-year-old man arrived at our emergency department presenting with sepsis and acute scrotal pain. Emphysematous epididymo-orchitis was diagnosed by scrotal sonography initially; however, advanced rectal cancer with prostate invasion was diagnosed by CT after a recurrent episode. An exploratory laparotomy with abdominoperineal resection and radical prostectomy were performed after neoadjuvant chemoradiotherapy. Histopathologic analysis confirmed the previous diagnosis. Emphysematous epididymo-orchitis caused by advanced rectal cancer is very rare, and our case is the first to be reported according to a literature search. Neoadjuvant chemoradiotherapy plus extended surgery can achieve a good oncological outcome.
  
  
  CONCLUSIONS
  This case indicated that the very rare presentation as emphysematous epididymo-orchitis caused by locally advanced colorectal cancer.
authors.affiliation: Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center Division of Urology, Department of Surgery, Tri-Service General Hospital, Song-Shan Branch, Taipei Department of Nutritional Science, Fu Jen Catholic University, New Taipei City Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Ching-Heng
authors.initials: CH
authors.lastname: Yen
authors.forename: Chin-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Tai-Lung
authors.initials: TL
authors.lastname: Cha
authors.forename: Sheng-Tang
authors.initials: ST
authors.lastname: Wu
authors.forename: En
authors.initials: E
authors.lastname: Meng
authors.forename: Guang-Huan
authors.initials: GH
authors.lastname: Sun
authors.forename: Dah-Shyong
authors.initials: DS
authors.lastname: Yu
authors.forename: Hong-I
authors.initials: HI
authors.lastname: Chen
authors.forename: Sun-Yran
authors.initials: SY
authors.lastname: Chang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tsao
mesh_terms: D059787:Acute Pain / Q000209:etiology; D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003951:Diagnostic Errors; D004646:Emphysema / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004823:Epididymitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009920:Orchitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D012007:Rectum / Q000473:pathology; D012008:Recurrence; D014057:Tomography, X-Ray Computed