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• W4367336514 abstract "Inguino-scrotal sepsis after intraperitoneal infections is a recognised but uncommon complication. Incidence of this condition seems to have decreased due to routine use of broad-spectrum antibiotics. The mechanism is thought to be a persistent communication with the peritoneal cavity, in the form of a hernia or processus vaginalis. Intrascrotal infection can lead to testicular loss due to vascular thrombosis. The treatment is operative drainage. An 8-year-old boy was admitted with a 2-day history of abdominal pain, vomiting and loose stools. On examination he was generally unwell with a oral temperature of 38°C. There was widespread abdominal tenderness and guarding. Blood film showed leukocytosis of 18×109. Appendicitis was diagnosed and he underwent standard appendicectomy the same day under antibiotic cover (cefuroxime and metronidazole). An inflamed appendix with free pus in the peritoneum was found. No peritoneal lavage was undertaken, although the pus was aspirated and mopped. Antibiotics were continued postoperatively. Pyrexia returned 24 hours after operation, and there was associated paralytic ileus. On day 3 postoperation the boy complained of scrotal pain. The left side of the scrotum was found to be swollen and inflamed. The cord structures were swollen and tender, as was the testicle. Testiculartorsion was diagnosed. Exploration of the scrotum produced pus in the tunica vaginalis, the testis and cord structures. No communication with the peritoneum could be demonstrated. Drainagewithprimary closure and placement of Yate's drain was under- taken. Postoperative recovery was slow but uneventful and complete. Culture swab from scrotal pus grew E. coli, as had the swab from the original operation. The organisms were sensitive to the antibiotics taken. On further enquiry the mother disclosed that at the age of 2 years there had been a queried left-sided inguinal hernia. This had been discounted on follow-up and there had since been no suggestion of a recurrent groin swelling. While inflamed appendix in a groin hernia is a well-described if uncommon condition,1 scrotal sepsis after inflammation of a normally located appendix is less common. Inguino-scrotal suppuration is an uncommon but recognised complication of intraperitoneal sepsis.2,3 It is believed to be due to a persistent communication with the peritoneal cavity in the form of a patent processus vaginalis or the presence of an indirect hernia. The process is similar to the development of intraperitoneal abscess. The incidence of this condition has decreased due to widespread and effective antibiotic treatment.4 In this patient there had previously been a suggestion of a left-sided hernia. This raises the possibility of a persistent communication, albeit at a subclinical level, allowing infected material to track into the tunica vaginalis. It has been suggested that peritoneal lavage might increase the chances of this complication.4 In this case no lavage was performed. The danger of the condition lies in the risk of testicular loss due to vascular thrombosis secondary to sepsis. History, or the presence or suspicion of a hernia, should alert the surgeon to the possibility of this complication; early intervention should be the treatment." @default.
• W4367336514 created "2023-04-30" @default.
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• W4367336514 date "1995-09-01" @default.
• W4367336514 modified "2023-09-26" @default.
• W4367336514 title "Scrotal suppuration after appendicitis" @default.
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• W4367336514 doi "https://doi.org/10.1111/j.1742-1241.1995.tb09983.x" @default.
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