Acute epididymo-orchitis complicated by outcomes of either testicular necrosis or complete recovery: Two case reports

Abstract

Rationale: Acute epididymo-orchitis, a common urological emergency requiring prompt intervention to prevent complications like testicular ischemia. This study highlights the use of serial Doppler ultrasound monitoring in patients with acute epididymo-orchitis, particularly in high-risk individuals.

Patient concerns: Case 1: A 70-year-old male with a history of bladder cancer, prostate malignancy, and hypertension, presented with scrotal swelling, pain, and lower abdominal discomfort. Physical examination revealed an enlarged and tender right testicular epididymis, with normal findings on the left. Ultrasound showed increased blood flow to the right testicular epididymis, indicating inflammation. Case 2: A 34-year-old male presented with scrotal swelling, pain, and lower abdominal discomfort. Ultrasound revealed increased testicular and epididymal blood flow, suggesting inflammation. The antibiotic therapy was adjusted according to the continuous ultrasound monitoring.

Diagnoses: Both cases were ultimately diagnosed as testicular epididymal inflammation.

Interventions: Patient 1 underwent anti-inflammatory therapy and orchiectomy. Patient 2 was treated with antibiotic therapy and recovered.

Outcomes: Patient 1 experienced testicular necrosis, whereas Patient 2 achieved a full recovery.

Lessons: The importance of serial Doppler ultrasonography: delayed follow-up imaging in this case allowed ischemic changes to progress irreversibly, despite initial Doppler findings showing increased perfusion. Early and repeated imaging is critical to monitor disease progression and guide timely interventions. Limitations of inflammatory markers: the disease worsened although the patient's leukocytosis and IL-6 levels improved markedly during treatment, highlighting that relying solely on blood tests is insufficient to determine treatment efficacy. Patient-specific risk stratification: high-risk individuals require more aggressive diagnostic and therapeutic protocols to prevent irreversible complications.

Keywords: case report; complication; epididymo-orchitis; orchiectomy; testicular necrosis.

Figure 1.

Scrotal ultrasound images in a 70-yr-old patient with scrotal pain. (A) Initial color Doppler ultrasonography reveals markedly increased blood flow in the right testis as compared to the physiological perfusion patterns in the left testis. (B) Day-11 follow-up ultrasound reveals disappeared perfusion in the right testis relative to the normal vascularity in the left testis.

Figure 2.

Gross and histopathologic features of testicular infarction in the patient with acute epididymo-orchitis. (A) Intraoperative gross specimen demonstrating ischemic pallor. There is no bleeding upon compression (arrow). Cross-sectional view reveals a gray-white peripheral zone with central gray-red discoloration. (B) Low-power (10×) hematoxylin-eosin staining showed extensive coagulative necrosis of testicular parenchyma (left). High-power magnification (200×) highlighted neutrophilic infiltration, with pyknotic nuclei and eosinophilic cytoplasmic changes (right).

Figure 3.

Transscrotal ultrasound imaging in a 34-yr-old patient with acute scrotal pain. (A) Initial color Doppler examination demonstrates markedly increased blood flow in the right testis, with comparative normal blood flow signals observed in the left testis. (B) The next day, an ultrasound reexamination showed that the vascular congestion in the right testicle was significantly increased compared to the left testicle and the previous examination.