A Tender Scrotum and Inguinal Mass Caused by Pancreatitis

Abstract

3 45-year-old man presented to our emergency department complaining of a 10-day history of bdominal pain that radiated to the back initially nd to the lower abdomen subsequently. He recalled n alcohol binge before presentation of the pain. On xamination, a tender and hyperemic mass, 5 cm in ize, was noted in the left inguinal area. In addition, he left scrotum appeared swollen and hyperemic. aboratory test results revealed a white blood cell ount of 24,310/ L, a C-reactive protein level of 3.66 mg/dL (normal, .8), a lipase level of 157 U/L normal, 30), and a serum creatinine level of 1.2 g/dL (normal, .6 –1.3). A panoramic-view transabominal ultrasonography showed the inguinal mass nd swollen scrotum to be an accumulation of panreatic ascites that extended from the left retropertoneal pararenal space to the scrotum (Figure A, rrows, S, scrotum). The retroperitoneal pancreatic scites were thought to dissect along the processus aginalis peritonei (called the canal of Nuck in feales) in the inguinal canal to the scrotum. A ontrast-enhanced abdominal computed tomograhy scan revealed severe pancreatitis with multiobulated fluid collections (Figure B, arrows). The ancreatic ascites also extended to the scrotum long the left retroperitoneum, as shown on the eformatted oblique coronal view (Figure C, arrows). fter conservative medical treatment, the sympoms and scrotal swelling gradually subsided. The atient was discharged 2 weeks later in stable ondition. Acute inguinoscrotal swelling, with or without crotal tenderness, rarely complicates the disease rocess of acute pancreatitis. Such presentation ould be mistaken for testicular torsion, scrotal nfarction, or incarcerated inguinal hernia and ight elicit unnecessary surgical explorations. ransabdominal ultrasonography, as a noninvaive and available bedside examination tool, offers mmediate help in determining the differential iagnosis. The patient described herein should emind clinicians to take the pancreas into conideration when seeing a swollen and painful crotum, especially when accompanied by abdomnal pain.