Scrotal abscess is a encapsulated purulent focus in the tissues of the scrotum. It can be primary or secondary, superficial or intramuscular. It is rare. It develops with atheroma infection, surgical interventions and traumatic injuries, or is a complication of bacterial infection in the testicle and its appendage. Symptoms of scrotal abscess are intense pain, swelling, hyperemia and local hyperthermia in the affected area. There is an increase in body temperature to febrile numbers, weakness, bruising, headache, pain in joints and muscles. The treatment is surgical, an autopsy and drainage of the abscess is required against the background of antibacterial therapy.
ICD 10
49.2 (Inflammatory diseases of the scrotum)
General information
Scrotal abscess is a rare pathological condition. The frequency of development is unknown, isolated cases are mentioned in the literature without indications of the prevalence of the disease. It may occur primarily or develop against the background of other pathological processes. Most often, scrotal abscesses are diagnosed, which are a complication of acute purulent epididymoorchitis.
Despite the rather superficial location of the purulent focus, the disease can present difficulties during diagnosis due to pronounced edematous infiltrative processes and diffuse pain in the area of abundantly innervated soft tissues of the scrotum, perineum and penis. Treatment of scrotal abscess is carried out according to the general principles of purulent surgery. Therapeutic measures are carried out by specialists in the field of andrology and urology.
Causes
The causative agent of the purulent process is most often hemolytic Staphylococcus, Staphylococcus aureus or microbial associations. Scrotal abscesses caused by salmonella, brucella, pale spirochetes, candida and anaerobic microorganisms are less often diagnosed. Local factors contributing to the development of scrotal abscesses include
- small thickness of the epidermis
- increased humidity of the organ skin
- loose subcutaneous tissue
- a large number of sweat and sebaceous glands.
Due to the proximity of the urethra and the anus, a large number of highly virulent microorganisms that can cause an abscess enter the skin of the scrotum. The peculiarities of blood and lymph supply to the scrotum create favorable conditions for slowing the outflow of fluid and the development of pronounced edema against the background of thrombophlebitis and lymphostasis.
Common predisposing factors that increase the likelihood of scrotal abscess are
- non-compliance with the rules of personal hygiene by socially disadvantaged patients
- immune disorders due to chronic somatic diseases, obesity, diabetes mellitus, malignant neoplasms, AIDS, drug addiction and alcoholism.
The immediate cause of an abscess of the scrotum in adults is most often purulent inflammation of the testicle and its appendage. Less often, pyoderma (pustular lesions, boils, carbuncles), suppuration of atheromas, open traumatic injuries (stab and incised wounds, gunshot wounds) and infection in the area of postoperative wounds are indicated as the cause of this pathology.
Cases are described when an abscess of the scrotum in adults developed with Crohn’s disease, paracolitis and acute destructive pancreatitis as a result of the spread of infection through the fiber of the retroperitoneal space and pelvis. In young children, the cause of an abscess of the scrotum sometimes becomes the spread of the infectious process from the internal organs into the scrotum through the uninfected vaginal process of the peritoneum.
Classification
Taking into account the localization, there are:
- superficial (located in the skin and surface layers of the organ)
- internal or intramuscular (intra-testicular and intravaginal) abscesses of the scrotum.
Taking into account the causes of development , there are:
- primary
- secondary (being a complication of another pathological process) defeats.
Superficial purulent foci can be both primary and secondary. Internal abscesses of the scrotum are usually secondary in nature and arise as a result of the spread of infection from the organs of the scrotum, less often from other anatomical areas.
Symptoms
Scrotal abscess is characterized by rapid development. The patient has pain, there is swelling in the scrotum. In the next few days, there is a sharp increase in pain syndrome and the progression of edema. The skin of the scrotum turns red, there is an increase in local temperature. Local symptoms of scrotal abscess are combined with general signs of a purulent process. The patient complains of weakness, bruising, headaches and musculoskeletal pains. An increase in temperature to 38-39 degrees is detected.
In some cases, there is a septic variant of scrotal abscess with rapid progression of symptoms and pronounced systemic inflammatory reactions. When infected with fungi, pale spirochete and Mycobacterium tuberculosis, there may be an erased course with moderate pain syndrome and an increase in temperature to subfebrile figures. In the absence of treatment, a breakthrough of the scrotal abscess and further spread of infection is possible. Sometimes, due to blood flow disorders in the scrotum skin, hemorrhages occur, followed by the formation of superficial foci of infection in the affected tissues.
Diagnostics
When examining a patient with an abscess of the scrotum, significant swelling, local hyperemia and hyperthermia in the affected area are revealed. The scrotum is sharply painful on palpation. The following diagnostic procedures are performed:
- Ultrasound of the scrotum. To clarify the localization and stage of the abscess, sonography is usually prescribed.
- Laboratory tests. According to blood test, an increase in ESR and leukocytosis with a shift to the left are determined.
If an infectious process is suspected of spreading from the pelvis, abdominal cavity or retroperitoneal space, CT and MRI are used, which allow to obtain information about the state of several anatomical areas, to clarify the localization of the primary focus and the pathways of infection.
Treatment
The patient is urgently hospitalized in the andrological or urological department. In the early stages, antibacterial and anti-inflammatory drugs are prescribed. After the “maturation” of the abscess, the scrotum abscess is opened and drained. In severe destructive processes in the testicular area, an orchiectomy is performed. When the purulent process spreads from other anatomical areas, the volume of intervention is expanded. Subsequently, bandages are performed, antibacterial therapy is adjusted taking into account the sensitivity of the microflora.
Forecast
The prognosis for life with an abscess of the scrotum is usually favorable. With a prolonged course of the disease, the formation of fistulas and swelling in the perineum and pararectal tissue is possible. A rare but dangerous complication of scrotal abscess is Fournier gangrene – lightning necrosis of scrotal tissues. The probability of developing a fatal outcome with this complication, according to various data, ranges from 50 to 80%. In the long-term period after an abscess of the scrotum, there is sometimes a violation of the functions of the testicle, the appendage of the testis and the vas deferens with the development of androgen insufficiency or male infertility.