Pneumoscrotum: report of two different cases and review of the literature

Abstract

Pneumoscrotum is the term used to describe the presence of air within the scrotum and includes scrotal emphysema as well as pneumatocele. The etiology varies; in some cases, pneumoscrotum may be due to life-threatening disease like pneumothorax or Fournier gangrene. Despite this, pneumoscrotum is a rarely debated issue. We present two different cases of pneumoscrotum and a review of the literature. The first case report is about a 29 year old male patient affected by Duchenne syndrome who showed pneumoscrotum after cardiopulmonary resuscitation that was performed for asphyxic crisis and cardiovascular arrest. We carried out local puncture with an 18-gauge needle, and the pneumoscrotum was successfully solved. The second case report is about a 56 year old male with pneumoscrotum due to Fournier gangrene who underwent radical exeresis of all necrotic tissues and drainage. This is why most of the scrotal skin and all of the penis skin were removed; as a result, the testicles, epididymis, and cavernosa corpora were externalized. On postoperative day one, the patient was feverless and underwent hyperbaric chamber therapy. No postoperative complications occurred. Accurate evaluation of the pneumoscrotum is always needed. Despite the benign course of most of the clinically evident pneumoscrotum cases, this condition should never be underestimated.

ERCP-Related Duodenal Perforation Presenting as Pneumoscrotum

“…This air can further dissect along fascial planes and subcutaneous tissues of the neck presenting as subcutaneous emphysema. However, in rare circumstances, the retroperitoneal air can travel downwards along fascial planes to reach the scrotum, resulting in pneumoscrotum [ 5 , 10 ]. Abdominal fascial planes include the superficial fascia of Camper and deep fascia of Scrapa.…”

“…These fasciae are distinct in the abdomen but fuse to form Colles’ fascia at the base of the penis and Darto's fascia in the testes. Air can track along these fascial planes to reach the scrotum [ 5 , 10 ]. Also, the retroperitoneal air in the perinephric space can diffuse through the inguinal canal along the spermatic fascia to reach the scrotum [ 5 ].…”

Pneumoscrotum as a presentation of necrotising enterocolitis

“…It is uncommonly reported in neonates. [1][2][3] Air may reach the scrotum by one of the three mechanisms: intraperitoneal air (after gut perforation, referred as scrotal pneumatocele); extraperitoneal air from lungs, mediastinum or retroperitoneum dissecting through fascial planes into the scrotal wall; and local scrotal causes (trauma, gas gangrene). 1 3 An inguinal hernia is one of the differentials of brilliant transillumination in the scrotum, but the clinical presentation made us to think of pneumoscrotum.…”

Pneumoscrotum With Extensive Penile and Abdominal Subcutaneous Emphysema: A Case Report of Uncertain Etiology

“…Lastly, air can spread via an intra-abdominal path through the peritoneal cavity and into the scrotum via the processus vaginalis. 1 , 2 Varying sources for pneumoscrotum have been identified with a distinction made as to whether it is primary or secondary in nature. Primary etiologies derive from the scrotum itself.…”

“… 2 Secondary pneumoscrotum is due to an air source elsewhere within the body, tracking via the mechanisms previously described, and commonly involve iatrogenic causes. 2 Examples include blunt chest trauma with resultant pneumothorax and spread of air, 1 visceral perforation due to endoscopic procedures, 3 or medical conditions like diverticulitis. 4 The presence of pneumoscrotum therefore warrants a comprehensive evaluation and work up to rule out perilous causes.…”