Acute appendicitis mimicking acute scrotum: a rare complication of a common abdominal inflammatory disease

Abstract

Introduction Acute appendicitis is the most common surgical disease of the abdomen in clinical practice, affecting mainly young adults. It has a wide variety of clinical presentations, due to the anatomical variation of the cecal appendix. Its presentation as acute scrotum and scrotal abscess is quite rare and atypical, occurring mainly in young male patients with patent processus vaginalis. Case presentation An 18-years-old male patient attended the emergency unit complaining of diffuse abdominal pain, fever and hyporexia for four days followed by inflammatory signs in the scrotum. He was taken to the operation room after diagnosis of scrotal and abdominal sepsis. During scrotum exploration, pus was found inside the right hemiscrotum coming down from the groin and communicating with the abdominal cavity. The laparotomy found perforated appendicitis and peritonitis leading to the scrotal abscess. The abscess was drained, appendectomy was performed and the scrotal and abdominal cavity were washed with saline solution. Despite postoperative complications such as pneumonia and intra-abdominal abscess, the reported patient recovered and was discharged in the 44th postoperative day. Conclusion Acute appendicitis can mimic acute scrotum and surgeons must have a high index of suspicion of this complication for diagnosing. This unusual clinical presentation may be challenging and can delay the diagnosis leading to perforated peritonitis.

Clinical Approach in the Diagnosis of Acute Appendicitis

“…One case of acute appendicitis mimicking acute scrotum was reported by Buzatti et al [93] in a young male who presented with diffuse abdominal pain of 4-day duration, accompanied by fever and anorexia. On physical examination the scrotum was red and swollen, and there was tenderness by direct percussion of the lower abdomen.…”

Nonscrotal Causes of Acute Scrotum

“…The patency of the processus vaginalis allows direct communication between the abdomen and the scrotal sac; therefore, some abdominal conditions that extend to the scrotum can manifest themselves as acute scrotum. This has been well documented in children with acute appendicitis 47–50 . In adults, scrotal pain may be elicited either through stimulation of the pelvic plexus or by direct irritation of the scrotal innervation.…”

Acute appendicitis in adults

“…In a few cases of retrocaecal appendicitis, pain may be referred to the right testis or to the right hemiscrotum. [9][10][11] A multitude of signs have been described for diagnosing acute appendicitis. 2 Tenderness at the Mac Burney's point is pathognomonic in majority of cases.…”