急性胰臟炎引發之陰囊膿瘍：一個病例報告

楊鎧伍¹、陳丕哲¹

嘉義基督教醫院 外科部 泌尿科¹

Acute pancreatitis complicating with scrotal abscess: A case report

Kai-Wu Yang¹, Pi-Che Chen¹

Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital¹

Introduction: 

   Severe pancreatitis had been report to associate with extrapancreatic necrosis (EPN), such as necrotizing fasciitis of the retroperitoneum or abdominal wall. However, extension of retroperitoneal necrosis to the scrotum is rare. In this report, we present a case of acute necrotising pancreatitis with collection in right pararenal space tracking all the way to reach the right inguinal canal till the root of scrotum, being managed successfully after early diagnosis with early debridement and application of vacuum assisted drainage.

Case presentation: 

    This 51-year-old male with underlying of alcoholic liver disease suffered from whole abdominal pain for 3 days. Laboratory reported bandemia up to 45%, Lactate acidosis, impairment renal function and elevated Lipase level (838 U/L). Non-contrast computed tomography (CT) confirmed the diagnosis of acute pancreatitis. He was resuscitated with intravenous fluids, 3 vasopressor agents (Levophed plus Pitressin plus Dopamin), and intubation and admitted to Intensive Care Unit on 2022/06/27.

    During the 6th day of hospital stay, right scrotum redness, swelling and tenderness were noted. Repeated abdominal CT revealed acute pancreatitis with significant pseudocysts and abscess formation with progressive change along with retroperitoneal space to right inguinal area. Therefore, scrotal incision and drainage were arranged and revealed right scrotal abscess extended to inguinal area. Repeat debridement was done on the 8th and 16th day of hospital stay. Besides, considering pancreatitis fluid accumulating, vacuum ball insertion at retroperitoneal space was also done.

   After no more pus formation, wound closure was done on day23. However, due to still some pus from the vacuum ball at retroperitonium, general surgery suggested keeping it and he was discharged on 2022/08/04. The drainage amount decreased day by day and was removed smoothly without complication on 8/29.

Conclusion: 

        The case reminds us about a rare but potentially fatal complication of scrotal abscess following severe acute necrotizing pancreatitis. Early diagnosis and surgical debridement with drainage at retroperitonium space can significantly reduce the associated mortality and morbility with necrotising pancreatitis and can prevent that scrotal abscess further progress to Fournier gangrene. Also, abdominopelvic Computed Tomography can help us to differential this complication.