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1
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Papagrigoriadis S, Brandimarte G, Tursi A. Fistulating diverticulitis: a distinct clinical entity? Front Med (Lausanne) 2025; 12:1500053. [PMID: 40182848 PMCID: PMC11966039 DOI: 10.3389/fmed.2025.1500053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 02/14/2025] [Indexed: 04/05/2025] Open
Abstract
Introduction Diverticular disease (DD) of the colon has a number of phenotypes, including asymptomatic diverticulosis and complicated diverticulitis with bowel perforation or bleeding. The factor that affects the phenotype of this condition and leads to a wide range of clinical presentations is unknown. The formation of fistulas associated with diverticulitis has long been recognized, and they are treated according to ad hoc indications. We hypothesized that the formation of fistulas in diverticular disease exhibits such a wide range of variable anatomic features that it may be considered a distinct form of the condition, fistulating diverticulitis (FD). Methods We conducted a narrative review based on 50 years of publications covering a wide range of diverticulitis-associated fistulas, both common and uncommon. Results While there is abundant literature on common fistulas, such as colovesical and colovaginal fistulas, little is known about rarer fistulas, such as coloenteric fistulas, colocutaneous fistulas, and genitourinary tract fistulas. The majority of these fistulas are treated surgically, which is in contrast to the trend toward conservative management that is predominant in acute or chronic diverticulitis. Discussion Epidemiological and histological evidence support the hypothesis that FD may be a feature of chronic DD that requires individual management. Histopathology shows similarities with Crohn's disease. It remains unknown which underlying immune or genetic factors may be affecting the clinical presentation of these patients, leading to fistulation. We contend that there is adequate published evidence to characterize a distinct phenotype of FD that can involve the entire GI tract and other organs. Surgical guidelines may need to be modified to treat this small but important group, which predominantly requires surgical treatment.
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Affiliation(s)
- Savvas Papagrigoriadis
- IASO Hospital, Athens, Greece
- One Welbeck Digestive Health Centre, London, United Kingdom
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Rome, Italy
| | - Antonio Tursi
- Territorial Gastroenterology Service, Barletta-Andria-Trani Local Health Agency, Andria, Italy
- Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome, Italy
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2
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Toge T, Takekawa K, Okamoto K, Ueno H, Shinmoto H, Ito K. A case of emphysematous intrascrotal abscess secondary to sigmoid coloseminal fistula. Urol Case Rep 2023; 51:102596. [PMID: 37954551 PMCID: PMC10632120 DOI: 10.1016/j.eucr.2023.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
A 54-year-old male patient presented with pneumaturia. Right scrotal swelling was observed. CT showed an intrascrotal abscess with gas formation. MRI showed a fistula extending from the sigmoid colon to the seminal vesicles. Since there are many diverticula in the sigmoid colon, an abscess caused by diverticulitis may have formed a fistula. The scrotal abscess was drained; however, the pus discharge did not decrease. A colostomy was then performed, and the scrotal infection rapidly improved. Sigmoidectomy and fistula transection were performed 11 months after the colostomy. Prompt diagnosis of a sigmoid coloseminal fistula using imaging has led to optimal treatment.
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Affiliation(s)
- Takuya Toge
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuki Takekawa
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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3
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Sedrak M, Song A, Greenstein J, Hahn B. Man With Scrotal Pain. Ann Emerg Med 2023; 82:111-114. [PMID: 37349066 DOI: 10.1016/j.annemergmed.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Miriam Sedrak
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY
| | - Alexander Song
- Department of Radiology, Staten Island University Hospital, Staten Island, NY
| | - Josh Greenstein
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY
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4
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Bokhari A, Aldarwish H, Albladi F, Almarzooq A, Alqutayfi H, Alamer M. An Overview of Emphysematous Epididymo-Orchitis: A Systematic Review of Case Reports. Cureus 2023; 15:e38326. [PMID: 37261165 PMCID: PMC10228163 DOI: 10.7759/cureus.38326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
Emphysematous epididymo-orchitis (EEO) is a rare but serious condition that involves the presence of gas within the tissues of the testicle and/or the epididymis. It is a medical emergency that can be life-threatening if left untreated. Management of this condition may involve a combination of antibiotics, surgical drainage, and supportive care. In March 2023, A systematic review of case reports was conducted to identify and examine cases of EEO. We used PubMed, ScienceDirect, and Google Scholar for a methodical search. Only seven out of 136 studies met our criteria for this review of case reports. However, this review discusses symptom presentation, imaging findings, complications, and possible management of EEO.
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Affiliation(s)
- Akram Bokhari
- Department of Urology, University of Hail College of Medicine, Hail, SAU
- Department of Urology, Miami Cancer Institute, Florida, USA
| | - Hadi Aldarwish
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Fatima Albladi
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | | | - Hatim Alqutayfi
- Department of Surgery, King Faisal University College of Medicine, Al-Ahsa, SAU
| | - Mohammed Alamer
- Department of Surgery, King Faisal University College of Medicine, Al-Ahsa, SAU
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5
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Abdelkarim M, Alfares A, Aldarwish H, Albladi F, Abdelkarim A. Emphysematous Epididymo-Orchitis: A Rare Case Report. Cureus 2023; 15:e38358. [PMID: 37266058 PMCID: PMC10229755 DOI: 10.7759/cureus.38358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Emphysematous epididymo-orchitis is a rare and potentially fatal infection marked by the presence of gas in the epididymis and testicular tissue. Here, we describe the case of a 49-year-old male with a known past medical history of diabetes and hypertension who presented with right inguinoscrotal swelling and severe tenderness. An urgent scrotal ultrasound was obtained and revealed a fluid-filled avascular mass. Moreover, the non-contrast CT scan showed a mixture of air and fluid density in the right epididymis, perineum, and spermatic cord course. The medical team confirmed the diagnosis of emphysematous epididymo-orchitis. The patient refused the management plan at first, but later came back and accepted the procedure. A right orchidectomy with spermatic cord removal was performed without complications.
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Affiliation(s)
| | - Abdo Alfares
- Department of Urology, King Khalid Hospital, Hail, SAU
| | - Hadi Aldarwish
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Fatima Albladi
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
| | - Ahmed Abdelkarim
- Department of Surgery, Sulaiman Al Rajhi University, Al-Qassim, SAU
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6
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Waack A, Ranabothu M, Patel NJ. Epididymo-orchitis secondary to colovesical fistula. Urol Case Rep 2022; 45:102281. [DOI: 10.1016/j.eucr.2022.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
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7
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Thompson J, Patel A, Nicholson G. Seminal vesicle fistula: a rare pathology in complicated Crohn's disease. BMJ Case Rep 2022; 15:15/5/e226445. [PMID: 35523511 PMCID: PMC9083419 DOI: 10.1136/bcr-2018-226445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This case report describes a patient with complicated Crohn’s disease who presented to a routine gastroenterology clinic complaining of increasing white discharge from a chronic perianal abscess. MRI of the perineum established the diagnosis of a seminal vesicle fistula connecting to the perianal skin. He was treated conservatively, with optimisation of his Crohn’s disease medication regime. Seminal vesicle fistulation is a rare pathology.
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Affiliation(s)
- Jessica Thompson
- General Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Amit Patel
- Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Gary Nicholson
- General Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
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8
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Ilangovan S, Ghazanfar N, Chitale S. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac060. [PMID: 35280055 PMCID: PMC8906843 DOI: 10.1093/jscr/rjac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sanjana Ilangovan
- Correspondence address. Barnet Hospital, Royal Free Hospital NHS Trust, London EN5 3DJ, United Kingdom. Tel +44(0)7923291014; E-mail:
| | - Noman Ghazanfar
- Urology Department, Whittington Hospital, London N19 5NF, United Kingdom
| | - Sudhanshu Chitale
- Urology Department, Whittington Hospital, London N19 5NF, United Kingdom
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9
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Tay JYI, Hayes I, Fisher T, McMullin R. Complicated diverticular disease presenting as recurrent epididymo-orchitis: a case report. ANZ J Surg 2021; 91:E703-E705. [PMID: 33734549 DOI: 10.1111/ans.16751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jia Ying Isaac Tay
- Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian Hayes
- Colorectal Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Fisher
- Colorectal Surgery Unit, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Richard McMullin
- Department of Urology, Ballarat Base Hospital, Ballarat, Victoria, Australia
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10
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Xia ZX, Cong JC, Zhang H. Rectoseminal vesicle fistula after radical surgery for rectal cancer: Four case reports and a literature review. World J Clin Cases 2020; 8:5645-5656. [PMID: 33344556 PMCID: PMC7716322 DOI: 10.12998/wjcc.v8.i22.5645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A rectoseminal vesicle fistula (RSVF) is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage (AL). Limited literature documenting this rare complication is available. We report four such cases and review the literature to investigate the etiology, clinical manifestations, and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder.
CASE SUMMARY Four cases of RSVF were presented and summarized, and a further 12 cases selected from the literature were discussed. The main clinical symptoms in these patients were pneumaturia, fever, scrotal swelling and pain, anal pain, orchitis, diarrhea, dysuria, epididymitis and fecaluria. Imaging methods such as pelvic X-ray, computed tomography (CT), sinus radiography, barium enema and other techniques confirmed the diagnosis. CT was the imaging modality of choice. In cases presenting with reduced levels of AL, minimal surrounding inflammation, and controlled infection, the RSVF was conservatively treated by urethral catheterization, antibiotics administration and parenteral nutrition. In cases of severe RSVF, incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula.
CONCLUSION This study provides an extensive analysis of RSVF, and outlines, summarizes and examines the causes, clinical manifestations, diagnostic procedures and treatment options, in order to prevent misdiagnosis and treatment errors.
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Affiliation(s)
- Zhi-Xiu Xia
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Chun Cong
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Hong Zhang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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11
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Greear GM, Bechis SK. Emphysematous epididymitis following hydrocelectomy. Urol Case Rep 2020; 33:101361. [PMID: 33102060 PMCID: PMC7573954 DOI: 10.1016/j.eucr.2020.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022] Open
Abstract
Acute epididymo-orchitis is an inflammatory process caused by bacterial infection. Emphysematous epididymitis is an extremely rare manifestation characterized by gas within the epididymal tissues. We report a case of emphysematous epididymitis following hydrocelectomy in a patient with a history of spinal cord injury and chronic bacteriuria. The diagnosis was made by clinical and laboratory data with imaging demonstrating foci of gas within the epididymal structures. We hypothesize that intermittent catheterization may have contributed to bacterial translocation into the adjacent cord structures and development of infection. High level of suspicion leading to early diagnosis, aggressive antibiotics and adequate debridement are required.
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Affiliation(s)
- Garrick M. Greear
- UC San Diego Health, 200 West Arbor Drive #8897, San Diego, CA, 92103-7897, USA
| | - Seth K. Bechis
- Department of Urology, UCSD Comprehensive Kidney Stone Center, UC San Diego Health, 200 West Arbor Drive #8897, San Diego, CA, 92103-7896, USA
- Corresponding author. Tel.: 619 543 2628; fax 619 543 3475.
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12
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Storey B, Smith S, Bateman G, McLeod N. Unusual cause for recurrent epididymo‐orchitis: fistula from rectal stump to seminal vesicle. ANZ J Surg 2019; 90:164-166. [DOI: 10.1111/ans.15024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Benjamin Storey
- Department of UrologyJohn Hunter Hospital Newcastle New South Wales Australia
| | - Stephen Smith
- Department of General SurgeryJohn Hunter Hospital Newcastle New South Wales Australia
| | - Grant Bateman
- Department of RadiologyJohn Hunter Hospital Newcastle New South Wales Australia
| | - Nicholas McLeod
- Department of UrologyJohn Hunter Hospital Newcastle New South Wales Australia
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13
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Boulianne M, Bouchard G, Cloutier J, Bouchard A. Coloseminal vesicle fistula after low anterior resection: Report of a case and review of the literature. Int J Surg Case Rep 2018; 51:257-260. [PMID: 30219659 PMCID: PMC6139995 DOI: 10.1016/j.ijscr.2018.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A rectoseminal vesicle fistula after a low anterior resection for rectal cancer is a rare complication despite their anatomic proximity. From a Medline search from 1966 to date, a total of twenty-one previous cases of coloseminal vesicle fistula have been reported. From these cases, eleven were a complication of laparoscopic low anterior resection for rectal cancer. DESCRIPTION OF THE CASE This report presents the case of a 63-year-old patient who was readmitted to the hospital on the fifteenth postoperative day after his surgical intervention for fever, abdominal pain, dysuria and pneumaturia. A sinography with water-soluble contrast revealed a tract between the rectum and the seminal vesicle. The condition was treated conservatively with antibiotics, urinary catheter and a transanastomotic Malecot probe for abscess drainage. The fistula had completely recovered on postoperative day 71 and the patient is still symptoms free, six months after the complication developed. DISCUSSION This case reinforces the presumed link between anastomotic leakage and rectoseminal vesicle fistula in cases of low anterior resection while reviewing and summarizing similar previously reported cases on the course of the disease, diagnostic procedures and treatment options. CONCLUSION Seminal vesicle are susceptible to fistula in oncological resection of rectum. Both CT scan with water-soluble contrast or sinography are effective diagnostic examinations. Depending on the characteristics of the fistula, conservative approach may be adequate and benefits much less morbidities than the surgical options.
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Affiliation(s)
- M Boulianne
- PGY 2, General Surgery Program, CHU de Québec, Laval University, 2325 rue de l'Université, Quebec, Quebec, G1V 0A6, Canada.
| | - G Bouchard
- Division of Diagnostic Radiology, St-François d'Assise Hospital, CHU de Québec, 10 rue de l'Espinay, Quebec, Quebec, G1L 3L5, Canada
| | - J Cloutier
- Division of Urology, St-François d'Assise Hospital, CHU de Québec, 10 rue de l'Espinay, Quebec, Quebec, G1L 3L5, Canada
| | - A Bouchard
- Division of Colorectal Surgery, St-François d'Assise Hospital, CHU de Québec, 10 rue de l'Espinay, Quebec, Quebec, G1L 3L5, Canada
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14
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Yen CH, Liu CY, Cha TL, Wu ST, Meng E, Sun GH, Yu DS, Chen HI, Chang SY, Tsao CW. Emphysematous epididymo-orchitis as a camouflage of prostate invasion secondary to rectum cancer: A case report. Medicine (Baltimore) 2016; 95:e4385. [PMID: 27472731 PMCID: PMC5265868 DOI: 10.1097/md.0000000000004385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Emphysematous epididymo-orchitis is a rare cause of acute scrotum pain characterized by gas formation within the tissue. Diabetes mellitus and recto-seminal fistula secondary to sigmoid diverticulitis are generally accepted as being responsible for this disease. However, prostate invasion secondary to rectal cancer may be considered to be a newly identified pathogenetic mechanism. Herein, we report this rare case and illustrate the pathogenesis. CASE PRESENTATION A 69-year-old man arrived at our emergency department presenting with sepsis and acute scrotal pain. Emphysematous epididymo-orchitis was diagnosed by scrotal sonography initially; however, advanced rectal cancer with prostate invasion was diagnosed by CT after a recurrent episode. An exploratory laparotomy with abdominoperineal resection and radical prostectomy were performed after neoadjuvant chemoradiotherapy. Histopathologic analysis confirmed the previous diagnosis. Emphysematous epididymo-orchitis caused by advanced rectal cancer is very rare, and our case is the first to be reported according to a literature search. Neoadjuvant chemoradiotherapy plus extended surgery can achieve a good oncological outcome. CONCLUSION This case indicated that the very rare presentation as emphysematous epididymo-orchitis caused by locally advanced colorectal cancer.
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Affiliation(s)
- Ching-Heng Yen
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
- Division of Urology, Department of Surgery, Tri-Service General Hospital, Song-Shan Branch, Taipei
| | - Chin-Yu Liu
- Department of Nutritional Science, Fu Jen Catholic University, New Taipei City
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Guang-Huan Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Hong-I Chen
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sun-Yran Chang
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Chih-Wei Tsao
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
- Correspondence: Chih-Wei Tsao, Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Road, Neihu District, Taipei 11490, Taiwan (e-mail: )
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15
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Dagur G, Lee MY, Warren K, Imhof R, Khan SA. Critical Manifestations of Pneumoscrotum. Curr Urol 2016; 9:62-6. [PMID: 27390577 DOI: 10.1159/000442855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/28/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Pneumoscrotum is a critical, physical finding that may indicate significant morbidity and mortality. Accumulation of gas in the scrotum can be primary or secondary. OBJECTIVE This paper discusses rapid diagnosis and treatment options. MATERIAL AND METHODS PubMed searches for pneumoscrotum, etiology, diagnosis, and treatment. RESULTS We review the historical perspective, classification, etiology, diagnosis, and treatment options of pneumoscrotum, as well as the presentation of pneumoscrotum in neonates/infants. CONCLUSION It is crucial to diagnose the etiology pneumoscrotum and designing a treatment option based off that.
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Affiliation(s)
- Gautam Dagur
- Department of Physiology and BiophysicsSUNY at Stony Brook, New York, N.Y., USA
| | - Min Y Lee
- Department of Physiology and BiophysicsSUNY at Stony Brook, New York, N.Y., USA
| | - Kelly Warren
- Department of Physiology and BiophysicsSUNY at Stony Brook, New York, N.Y., USA
| | - Reese Imhof
- Department of Physiology and BiophysicsSUNY at Stony Brook, New York, N.Y., USA
| | - Sardar A Khan
- Department of Physiology and BiophysicsSUNY at Stony Brook, New York, N.Y., USA; Department of Urology, SUNY at Stony Brook, New York, N.Y., USA
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16
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Dagur G, Warren K, Singh N, Khan SA. Detecting diseases of neglected seminal vesicles using imaging modalities: A review of current literature. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.5.293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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17
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Seminal vesicle-rectal fistula secondary to anastomotic leakage after low anterior resection for rectal cancer: a case report and brief literature review. Int Surg 2015; 99:23-7. [PMID: 24444264 DOI: 10.9738/intsurg-d-13-00164.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We report a case of a patient with seminal vesicle-rectal fistula, an extremely rare complication of low anterior resection of the rectum. A 53-year-old man with rectal adenocarcinoma underwent low anterior resection in our hospital. The patient experienced diarrhea, pneumaturia, and low-grade fever on postoperative day 13. A computed tomography scan showed emphysema in the right seminal vesicle. We concluded that anastomotic leakage induced a seminal vesicle-rectal fistula. The patient underwent conservative therapy with total parenteral nutrition and oral intake of metronidazole. Diarrhea and pneumaturia rapidly improved after metronidazole administration and the patient was successfully cured without invasive therapy such as colostomy or surgical drainage. A seminal vesicle-rectal fistula is a rare complication of low anterior resection, and therapeutic strategies for this condition remain elusive. Our report provides valuable information on the successful conservative treatment of a secondary seminal vesicle-rectal fistula that developed after low anterior resection of the rectum in a patient.
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18
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Mandava A, Rao RP, Kumar DA, Naga Prasad IS. Imaging in emphysematous epididymo-orchitis: A rare cause of acute scrotum. Indian J Radiol Imaging 2014; 24:306-9. [PMID: 25114397 PMCID: PMC4126149 DOI: 10.4103/0971-3026.137067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue. Patient presents with fever, acute pain, swelling and tenderness in the scrotum. Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion. We report a case of emphysematous epididymo-orchitis with imaging findings on plain radiography, ultrasound, CT and MRI and a brief review of the literature.
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Affiliation(s)
- Anitha Mandava
- Department of Radiodiagnosis, Central Hospital, Lalaguda, South Central Railway, Secunderabad, Andhra Pradesh, India
| | - R Prabhakar Rao
- Department of Radiodiagnosis, Central Hospital, Lalaguda, South Central Railway, Secunderabad, Andhra Pradesh, India
| | - D Anjani Kumar
- Department of Radiodiagnosis, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
| | - I Shiva Naga Prasad
- Department of Surgery, Central Hospital, Lalaguda, South Central Railway, Secunderabad, Andhra Pradesh, India
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Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT. Jpn J Radiol 2014; 32:425-30. [DOI: 10.1007/s11604-014-0313-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/28/2014] [Indexed: 11/26/2022]
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Abstract
Emphysematous epididymo-orchitis is a rare cause of an acute scrotum and is a surgical emergency. Diagnosis is clinically difficult, and sonography with a high-frequency probe is useful to pick up gas shadows in the scrotal wall or testicular substance. A diabetic patient presented with fever, urinary tract infection, and an acute scrotal swelling. The patient needed orchidectomy and scrotal debridement. As in emphysematous pyelonephritis, this condition occurs in diabetics, and patients may need surgery. There is a need to perform sonography in all diabetic patients with an acutely inflamed scrotum, because detection of gas shadows makes surgical intervention more likely.
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Affiliation(s)
- Alok Mathur
- Department of Surgery, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
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21
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Hollingshead MC, Warshauer DM. Diverticular perforation masquerading as maxillary sinusitis. Emerg Radiol 2006; 13:83-5. [PMID: 16941111 DOI: 10.1007/s10140-006-0510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Accepted: 04/21/2006] [Indexed: 11/30/2022]
Abstract
Although diverticular perforation and diverticulitis is usually a straightforward diagnosis, an occasional case can be difficult. In this report, we describe a patient who initially presented with symptoms suggestive of maxillary sinusitis and hip fracture. Findings of subcutaneous craniofacial emphysema eventually led to the diagnosis of a perforated sigmoid diverticulum with abscess.
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Affiliation(s)
- Michael C Hollingshead
- Department of Radiology, CB 7510, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510, USA.
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