Scrotal abscess as the first symptom of fatal necrotizing pancreatitis

Abstract

Acute necrotizing pancreatitis represents a severe form of acute pancreatitis, characterized by pancreatic collections and necrosis of the pancreas and surrounding tissues. It is associated with higher rates of morbidity and mortality. Scrotal swelling is a rare complication of acute necrotizing pancreatitis due to the extension of pancreatic necrotic masses involving the inguinal canal and scrotum. We report a case of scrotal swelling as the first sign of unrecognized severe necrotizing pancreatitis with a fatal outcome.

Acute pancreatitis presenting as acute scrotum

“…Being rich in pancreatic enzymes, this fluid causes scrotal irritation, fat necrosis and sometimes secondary infection in the scrotum 2 10 11. Infertility as a result of scrotal extension of pancreatitis results from a direct inflammatory insult to the testis/epididymis and any secondary ascending infection 12–14. The scrotal oedema can also compromise testicular venous return and result in fluid accumulation and congestive varicocele increasing the risk of infertility 9 15…”

Inguinal and Perineal Necrotizing Fasciitis, A Rare Clinical Manifestation of Necrotizing Pancreatitis: Two Case Reports

“…Liquid collection in retroperitoneal space can descend to the scrotum and lead to edema of the scrotum and inguinal region, which is called pancreatic hydrocele, but it is not common [8]. Most patients with pancreatic hydrocele improve with treatment of pancreatic inflammation without surgery, and abscess formation is rare.…”

“…Acute pancreatitis etiologies include gallstones, alcohol consumption, trauma, and some medications [7]. Hyperlipidemia is another cause of acute pancreatitis in approximately 10% of cases [8]. According to the revised Atlanta classification 2012, there are two main presentations of acute pancreatitis: acute interstitial edematous pancreatitis which is presented more commonly and necrotizing pancreatitis.…”

“…One possible hypothesis is that cell death and fat necrosis occur after the release of pancreatic enzymes and the consequence is bacterial translocation into the tissue and infected collection [9]. Necrosis of the peripancreatic tissue can lead to the spread necrotic collections along the retroperitoneum, and in rare cases, it can develop into the scrotum [8,10]. One rare complication of necrotizing pancreatitis with mortality rate of 10% to 36% is emphysematous pancreatitis which is characterized by infected necrotic tissues with bubble of gas [11].…”

Acute necrotizing pancreatitis complicating as Fournier’s gangrene

“…6 Scrotal involvement of acute pancreatitis presents as unilateral or bilateral scrotal swelling with overlying skin changes, and sometimes it can be indistinguishable from other acute scrotal lesions, such as testicular torsion, acute epididymitis or a testicular tumor. 7,8 Color doppler ultrasonography features of acute pancreatitis-related scrotal swelling like sparing of testis and spermatic cord has been described in several reports but its correlation with pancreatitis is difficult to achieve, especially if the scrotal swelling is the main problem in a patient with acute pancreatitis. 9 Testes are typically not affected in pancreatitis-related scrotal swelling, because the fibrous tunica albuginea and tunica vaginalis cover the testes.…”