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Case Reports
. 2025 Apr 13;17(4):e82196.
doi: 10.7759/cureus.82196. eCollection 2025 Apr.

Diagnostic Challenges in Acute Infantile Epididymitis: A Case Report

Manabu Watari  1 , Shohei Yoshimura  2   3 , Hiroyuki Nagao  1 , Kengo Hattori  2 , Yo Okizuka  1
Affiliations
Case Reports

Diagnostic Challenges in Acute Infantile Epididymitis: A Case Report

Manabu Watari et al. Cureus. .

Abstract

Acute epididymitis is a rare yet significant cause of acute scrotum in infants, which presents diagnostic challenges owing to its similarity to other conditions requiring emergency surgery, such as strangulated inguinal hernia and testicular torsion. This report describes two cases of acute epididymitis in infants, emphasizing the importance of differential diagnosis in the emergency department. In case 1, a six-month-old male infant with swelling and erythema extending from the right groin to the scrotum was initially suspected of having a strangulated inguinal hernia. However, scrotal ultrasonography and urinalysis confirmed an acute epididymitis, and the patient responded well to antibiotics. In case 2, a three-month-old male infant with scrotal erythema and swelling required surgical exploration to rule out testicular torsion and was ultimately diagnosed with acute epididymitis. The patient was cured with antibiotics without relapsing. This report underscores the role of clinical evaluation, scrotal ultrasound, and laboratory tests such as urinalysis and serum C-reactive protein levels in diagnosing epididymitis and differentiating it from other acute scrotal conditions. However, surgical exploration is a useful diagnostic tool for acute infantile epididymitis. Early and accurate diagnosis of acute epididymitis using these examinations is crucial for preventing long-term complications.

Keywords: acute epididymitis; acute scrotum; c-reactive protein; emergency surgery; strangulated inguinal hernia; testicular torsion.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Physical and imaging findings in Case 1
A: Swelling and erythema from the right groin to the scrotum, and suspicion of an incarcerated inguinal hernia. B: Scrotal ultrasound image showing enlargement of the inferior epididymis and no patent processus vaginalis (white arrowheads). C: Voiding cystourethrography showing no vesicoureteral reflux or lower urinary tract abnormalities (black arrowheads). BL, bladder; E, epididymis; T, testis
Figure 2
Figure 2. Imaging and operative findings in Case 2
A: Scrotal ultrasound image showing enlargement of the entire epididymis, hydrocele, and lack of blood flow within the testis, suggesting epididymitis or testicular torsion. B: Surgical findings showing inflammatory enlargement of the epididymis with no testicular torsion, leading to a definitive diagnosis of epididymitis. E, epididymis; H, hydrocele; T, testis
See this image and copyright information in PMC

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