Penoscrotal Edema as a Rare Complication of Acute Pancreatitis: A Case Report

Abstract

Background and Objectives: Scrotal swelling or hydrocele is a rare complication of acute pancreatitis described in the literature. We present a case of penoscrotal swelling caused by the first attack of acute interstitial edematous alcohol-induced pancreatitis in a young male patient. Case report: A 22-year-old man was admitted to the emergency unit due to diarrhea and vomiting since morning which was followed by severe abdominal pain. Urgent abdominal multislice CT scan showed steatosis, pancreatic swelling and acute peripancreatic fluid collection (interstitial edematous pancreatitis). Also, scan showed fluid between small bowel loops and along the anterior renal fascia, while there was minimal amount of fluid in the Douglas space. There was no sign of penoscrotal swelling. On the second day of admission, the patient developed left scrotal swelling and mild pain without erythema. On the fourth day, a control CT scan showed progression to moderately severe pancreatitis (CT severity index 4). Dilated scrotal veins of the pampiniform venous plexus with an increased caliber of the testicular veins were present on both sides, from the scrotum to the level of the inguinal canal. Penoscrotal swelling was significantly reduced on discharge. Conclusions: Penoscrotal swelling is a rare complication or manifestation of acute inflammation of the pancreas. It is important to identify scrotal swelling caused by pancreatitis because in severe cases it can be related to possible infertility in the future.

Keywords: acute pancreatitis; hydrocele; peripancreatic fluid; scrotal edema; swelling.

Figure 1

(a). Axial contrast abdominal CT scan showed fatty liver disease, pancreatic swelling, and acute peripancreatic fluid collections (interstitial edematous pancreatitis), fluid between the intestinal coils and along the anterior renal fascia, and minimal fluid in the Douglas space on the first day of admission. (b). Axial contrast CT scan showed there was no sign of penoscrotal swelling on the first day of admission.

Figure 2

Axial contrast CT scan showed dilated scrotal veins of the pampiniform venous plexus with the indicated caliber of the testicular veins on both sides from the scrotum to the level of the inguinal canal—a progression compared to the earlier finding. There was no sign of acute compartment syndrome. The amount of free fluid in the scrotum and subcutaneous tissue of the penis was also progressing—edema. The testicles, spongy and cavernous bodies of the penis are properly imbibed post-contrast. Bilateral inguinal subcutis edema.

Figure 3

Penoscrotal swelling in 22-year-old patient.