Emphysematous epididymo-orchitis as a camouflage of prostate invasion secondary to rectum cancer

Yen, Ching-Heng; Liu, Chin-Yu; Cha, Tai‐Lung; Wu, Sheng‐Tang; Meng, En; Sun, Guang‐Huan; Yü, Dah‐Shyong; Chen, Hong‐I; Chang, Sun‐Yran; Tsao, Chih-Wei

doi:10.1097/md.0000000000004385

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…Colon cancer arising within a colonic diverticulum can also create such colovesical fistula [ 20 , 21 ]. Invasive colon cancer has also been known to have emphysematous presentation within the genitourinary system [ 22 ]. With multiple imaging modalities, direct visualization and pathological examination, we have definitively ruled out these more common etiologies for EC in our patient.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous cystitis as a potential marker of severe Crohn's disease

Hasan

Salh

2022

BMC Gastroenterol

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Background Emphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn’s colitis with no clinical evidence of UTI. Case presentation A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy. Conclusion This is a rare case of EC in a patient with severe Crohn’s colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.

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Section: Discussionmentioning

confidence: 99%

Emphysematous cystitis as a potential marker of severe Crohn's disease

Hasan

Salh

2022

BMC Gastroenterol

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“…This is different from Fournier’s gangrene, which usually spares the testicular and epididymal tissue [ 10 ]. In most of the reported cases, it was secondary to genito-colonic fistula formation [ 3 , 6 ] or recent urinary tract intervention [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Escherichia coli , originating from the lower genito-urinary tract, is one of the most common bacteria implicated in gas producing infections in diabetic patients [ 2 ]. However, with no evidence of seminal vesiculitis as a possible source and absence of genito-urinary tract fistula or recent endoscopic intervention as the two other possible underlying precipitating factors for such infection [ 3–6 ], such clinico-pathological findings of emphysematous epididymo-orchitis (EEO) are indeed rare.…”

Section: Introductionmentioning

confidence: 99%

Emphysematous epididymo-orchitis: imaging plays a vital part in active management: case report and literature review

Ilangovan

Ghazanfar

Chitale

2022

Journal of Surgical Case Reports

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We hereby present a rare cause of acute scrotum secondary to emphysematous epididymo-orchitis (EEO). It is often not diagnosed until crepitus is palpable in the scrotal wall with spreading cellulitis, at which point it has reached an advanced stage. This case report details a 55-year-old man with poorly controlled diabetes who presented with an acute scrotum that failed to resolve with oral antibiotics in primary care. Following rapid detection of EEO on an early scrotal ultrasound scan, the patient had surgical debridement and a near-total orchidectomy with only a small stump of testis and tunica albuginea left behind. This case highlights the importance of timely imaging, particularly in diabetic men with an acute scrotum with a high clinical suspicion of intratesticular abscess. An incidental but significant finding of EEO would warrant early surgical intervention to prevent a catastrophic sequelae i.e. Fournier’s gangrene.

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“…Emphysematous epididymitis, characterized by the presence of gas within the tissue, is rare with few case reports in the literature. 1 , 2 , 3 , 4 …”

Section: Discussionmentioning

confidence: 99%