國泰綜合醫院 外科部 泌尿科
Rare Differential Diagnosis of Acute Scrotal Pain: Spermatic Cord Hematoma Secondary to Varicocele Rupture
Case Report and Literature Review
Chung-Tso Chen, Shu-Wei Tsai
Divisions of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan;
Acute scrotal pain is a common complaint in a urological practice and should be evaluated rapidly for sources that may cause irreversible testicular ischemia. Testicular torsion or epididymitis are relatively common cause of acute scrotal pain. Differential diagnosis between these two diseases is usually mentioned in clinical practice. However, other cause of scrotal pain still needs to be considered and requires immediate exclusion, as presented in our case.
We present a case of 23-years-old male with acute left testis swelling and pain. On physical examination, swelling and tenderness of left testis was noted. Testicular ultrasound revealed detectable left testis blood flow and left spermatic cord heterogeneous change. Testicular torsion still cannot be rule out due to finding of physical examination. Emergent scrotal exploration was then performed. However, left peri-spermatic cord hematoma was discovered once we opened the fascia layer of scrotum. No evidence of testicular torsion was found. Spermatic cord hematoma secondary to pampiniform vein rupture was suspected. Blood clot removal, hemostasis and orchiopexy were performed. The patient was discharged shortly after the operation. We will present this case and review the relative literature.