唐靖 洪巨軒 王彥傑

國泰綜合醫院 外科部 泌尿科

Chin Tang, Chi-Hsuan Hung , Yen-Chieh Wang

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

 

  We present a case of an 8-year-old boy with no past medical history presented to our emergency department for left-lower-quadrate abdominal pain for 3 days. According to his statement, he developed sudden onset of LLQ abdominal pain after he attended swimming class. The pain didn’t radiate and he denied associate symptoms such as nausea, vomiting, fever, constipation, diarrhea, or dysuria. He was discharged after symptomatic treatment, but came back to our urologic outpatient clinic the next day complaining left scrotal swelling and pain. Physical examination revealed enlargement of the left hemi-scrotum with erythematous change. Scrotal ultrasound showed a massive heterogenous para-testicular cystic mass near the upper pole of the testis. Color doppler demonstrated obvious blood flow both to the testis and to the cystic mass. Scrotal exploration was later performed and a 4-cm-wide brown, unicystic, ischemic mass attached to a torsion band was identified and excised. Pathology revealed a hemorrhagic cyst walled by congested and hemorrhagic stroma and containing blood clots with certain inflammatory cells.

  Scrotal tunica cyst, which may develop from tunica albuginea or tunica vaginalis, is an uncommon benign intraepithelial mesothelial lesion that usually manifests as a palpable testicular lump. Torsion of the scrotal tunica cyst is a relatively new and rare entity with only a few cases being reported in the medical literature, and its clinical course can easily be confused with other diseases that cause acute scrotum. We present this case to share our experience of diagnosis and management of this peculiar disease.