A 10-year-old boy, who had a mild inguinal hernia in his left scrotum, was referred to our clinic because of redness of the scrotal skin and tenderness of the left scrotal contents. Scrotal echography showed a hypoechoic lesion around the normal testis and epididymis. Because torsion of either the testis or testicular appendage was suspected, the scrotum was opened and 1.5 mL of purulent fluid was observed in the tunica vaginalis with inflammatory tissue around the testis and epididymis. On the first postoperative day, a low grade fever and abdominal tenderness persisted, however, the abdomen was flat and soft. There was no marked tenderness over McBurney's point, but there was moderate tenderness over Lanz's point on deep palpation. Abdominal sonography and magnetic resonance imaging revealed abscess formation between the bladder and the sacrum. With a diagnosis of perforation of the appendix, a laparotomy was performed. The inguinal hernia sac could not be observed on inspection, and it was not possible to palpate the left side because of severe adhesion due to infection. Also, the neck of the right inguinal sac could not be seen. The appendix specimen was gangrenous. On the second postsurgical day, all symptoms and signs disappeared. We present this rare condition and discuss the difficulty in establishing a diagnosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.