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Case of the Month

May 2013

Patient Data: Male patient 7 years old

Clinical Info: The patient had an acute onset of scrotal pain during his vacation in a foreign country. An ultrasound examination in a foreign hospital showed an abnormality that the doctors there wanted to operate immediately. The parents however decided to have the child operated in their own country and drove back immediately by car. After 24 hours the ultrasound exanination was repeated in their home town. Was it a good idea of the parents to ignore the foreign doctors advise

Swollen testis and epididymis an small hydrocele

Normal testis and epididymis on the other side

Flow in the normal testis and epididymis

There is flow in the testis on the painful side

There is a scrotal hernia The distal part of the fatty tissue is infarcted and hypoechoic

Infarcted part transverse

Extended field of view showing the herniated fatty tissue with infarcted tip

A week later the swelling of the testis and epididymis is gone. There is still some hydrocele

There is normal flow in the epididymis

The scrotal hernia is still there. The infarcted part is less visible

The following case is also a male patient 26 year old With a painful swollen scrotum. The image shows dilatated small bowel loops in the scrotum.

The bowel loops are located cranial to a normal testis

This image clearly shows an indirect inguinal hernia with extension in the scrotum with a bowel loop in the scrotum and a hyrocele

Another image of the scrotal hernia with hydrocele. The dilatated bowel loop without peristalsis and hydrocele indicate an incarcerated scrotal hernia and immediate surgery is indicated

In a case of an acute onset of scrotal pain one should always think about a testicular torsion. If the first boy had had a testicular torsion, it would have been very unwise to postpone the operation. However although the testis and epididymis were swollen there was not a tesicular torsion. There was a scrotal hernia with herniated fatty tissue. This had become partially infarcted leading to swelling and this resulted in diminished flow in the testis and epididymis with swelling as a result At the time of the second examination 24 hours later the pain had diminished a bit but there was still some swelling. However the flow in the testis was normal. The infarcted part of the fatty tissue was clearly visible. The surgeon decided not to operate immediately. A week later the swelling was gone and the patient was operated The diagnosis scrotal hernia with partially infarcted fatty tissue was confirmed. Testis and epididymis were completely normal. The second patient also had a scotal hernia. There was an incarcerated bowel loop that needed immediate surgery

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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