Testicular Abscess Research Articles

(245) Epididymo-Orchitis as the First Presentation of Brucellosis in an Endemic Area

Abstract Introduction Brucellosis, which is also called Mediterranean or Malta fever, is an endemic enzootic disease and can involve various organ systems. It is commonly endemic in the Mediterranean countries and the Middle East. Epididymo-orchitis is a focal form of human brucellosis. Brucella species cause granulomatous orchitis usually presenting as an acute or chronic unilateral swelling of the testis. Patients rarely present to the clinicians with acute scrotum due to Brucellosis Epididymo-Orchitis (BEO) as an initial finding. Objective Our aim is to estimate the prevalence of the BEO among the cases diagnosed with Epididymoorchitis in our hospital over the last four years. Methods Retrospective study from 2015–2018 involving all cases diagnosed with Epididymoorchitis in our hospital. A total of 92 cases of Epididymoorchitis were diagnosed during this period. These cases presented to ER complaining of severe unilateral scrotal pain, swelling, fever and sweating. Local examination showed swollen enlarged testis and epididymis with marked tenderness. Brucella serologic test for both B abortus and B melitensis were requested routinely for all cases of epididymo-orchitis. Scrotal Doppler ultrasonographic examination was requested at initial diagnosis and after 2 weeks to exclude abscess formation. Results Out of 92 cases, 8 were diagnosed to have brucellosis (8.7%). The median age of patients was 32 years (range, 18–41 years). All patients had positive history of consuming unpasteurized dairy products, which is a risk factor for brucellosis. The diagnosis of brucellosis was made via positive serological testing results (Brucella abortus and melitensis). One case showed testicular abscess formation. All cases were given combination of tetracyclin and rifampicin for 6–12 weeks. Two cases required prolonged hospital stay due to testicular abscess formation in one and development of Brucellosis spondylitis in the other. Gentamycin was added for one week in such cases. Conclusions In endemic regions for brucellosis, we have to consider it in the workup of all cases of epididiymo-orchitis. The diagnosis is easy by positive serology tests. Positive cases need special antibiotic combination protocol for longer time and close monitoring for development of local complications or other systemic brucellosis manifestations Disclosure No.

Traumatic scrotal sac hematoma after a fall injury

Introduction and Importance: Traumatic scrotal sac hematoma is an uncommon medical condition following a fall injury. Symptoms include swelling, pain, and discoloration. Accurate and immediate diagnosis is crucial to avoid complications and prevent testis loss, abscess formation, erectile dysfunction, and infection. This case highlights the importance of prompt evaluation and treatment to prevent complications and ensure optimal patient outcomes. Case Presentation: A 56-year-old man without prior medical history presented to the emergency department with scrotal pain and swelling 10 h after a traumatic event. The patient underwent a series of examinations, including radiological studies, before undergoing scrotal exploration and hematoma evacuation under subarachnoid block anesthesia. As of now, the patient has not experienced any complications that have impacted his quality of life. Clinical Discussion: Scrotal sac hematoma is formed following a blunt trauma when a significant force is transferred during contact with a solid object, impact from sports equipment, road traffic accidents, or falls from a height. If early exploration is delayed, then it can lead to complications like testicular atrophy, abscess formation, and infection. Hence, prompt diagnosis with clinical and radiological evaluation followed by immediate surgical intervention can result in better outcomes. Conclusion: Scrotal sac hematoma from blunt trauma is rare but can cause significant morbidity and psychological distress. Early surgical intervention is often necessary, especially if a testicle has ruptured, to salvage viable testicular tissue and control bleeding, resolve pain faster, shorten hospital stays, and improve the quality of life for patients.

Características anatômicas e ultrassonográficas dos abscessos testiculares e microlitíase testicular: um estudo de caso de cinco carneiros cazaques

ABSTRACT Anatomical and ultrasonographic diagnostic work-up of testicular abscesses (n = 2) and testicular microlithiasis (n = 3) in Kazakh rams is described. For testicular abscesses, the localized symptoms include enlargement of the testicle and decreased elasticity, accompanied by varying degrees of pain and fever, abnormal behavior, walking or urinating with legs spread apart and accompanied by painful moans. Ultrasound findings: several hypoechoic or fluid dark areas with irregular morphology appear within the testicular parenchyma, with unclear borders with the surrounding normal tissues and uneven internal echogenicity. An autopsy revealed unilateral caseous necrosis with degeneration of all testicular tissues. Testicular microlithiasis does not present clinically and normal semen quality is not affected. Ultrasound findings: sparse, scattered, or dense punctate, pinpoint-like echogenic dots, some with comet tail signs and no acoustic shadow, are seen in the testicular parenchyma. The routine treatment for testicular abscesses is surgical drainage, but when degeneration and necrosis of testicular tissue occur, leading to severe systemic symptoms, the animal must be put down. Testicular microlithiasis is relatively rare and there are no effective treatments or interventions available, but it remains a potential contributor to testicular dysfunction and other secondary conditions.

Testicular Compartment Syndrome in a Case of Fulminant Necrotizing Orchitis

Abstract Testicular compartment syndrome (TCS) impedes the microcirculation in the testicle, resulting from increased venous resistance or an extraluminal compression that might lead to a cascade of hypoxia, ischemia, and gangrene. We report a case of fulminant necrotizing orchitis occurring in a 45-year-old immunocompetent patient in the form of TCS. The patient underwent imaging, which suggested extensive localized right testicular abscess formation, for which the patient underwent guided drainage from the abscess. Subsequently, the patient was started on culture-sensitive intravenous antibiotics. Due to the failure of conservative treatment and symptomatic deterioration, we planned scrotal exploration. Intraoperatively, we found that the testicular tissue was necrotic and completely replaced by frank pus, with an already ruptured tunica, due to higher compartmental pressure. The patient underwent a right orchidectomy. The postoperative course in the hospital was uneventful. We report that this case as TCS is rare, and all surgeons should be aware of such possibility of occurrence.

Primary paratesticular embryonal rhabdomyosarcoma - An unusual presentation.

Paratesticular embryonal rhabdomyosarcoma (RMS) is a very rare and aggressive mesenchymal tumor. It is usually seen in children and adolescents presenting as a painless intrascrotal mass, localized in the paratesticular region. Hereby, we report two cases of paratesticular embryonal RMS in adults. One case was clinically suspected to be a testicular abscess, whereas the other presented with testicular swelling and lung metastasis. Localized forms have a good prognosis, whereas tumors presenting with metastases show a poor outcome. A treatment based on surgery and chemotherapy yields good results. Sperm cryopreservation and endocrine follow-up improve the overall survival and quality of life of these patients.

Outcome of acute epididymo-orchitis: risk factors for testicular loss

PurposeAcute epididymo-orchitis (AEO) is a common urological condition characterised by pain and swelling of the epididymis which can affect men of any age. The aetiology and to some extent the management of the patient differ between paediatric and young and older adult groups.MethodsA retrospective analysis was performed at the University Hospital Limerick from 2012 to 2016. Hospital In-Patient Enquiry (HIPE) data were obtained for all patients diagnosed with orchitis, epididymitis, epididymo-orchitis or testicular abscess over this 5-year period.Results140 patients were identified, the age range was 0–89, median age 35.6. These were then split into 3 clinical groups, pre-pubertal (Group 1, 0–15-year-olds), sexually active young men (Group 2a, 16–35-year-olds) and men over 35 (Group 2b). Nine patients had an abscess on ultrasound investigation. There was a significant correlation between the presence of an abscess and the need for an orchidectomy (2 patients, P = 0.035). Two patients were reported as having an atrophic testis following AEO and both were in Group 2b.ConclusionOverall, 7/131 (5%) patients had loss or atrophy of a testicle following an episode of AEO. Nineteen patients had further readmissions with AEO (14%).

Imaging Findings of Testicular Abscess and Sacroiliitis as a Rare Complication of Brucellosis

Imaging Findings of Testicular Abscess and Sacroiliitis as a Rare Complication of Brucellosis

A case of testicular seminoma with testicular abscess caused by Salmonella saintpaul.

Testicular abscesses are rarer than epididymitis and orchitis. Here, we report a case of testicular seminoma with testicular abscess caused by Salmonella saintpaul. A 41-year-old male was referred for painful enlargement of the right scrotal content and fever for 1week. With the diagnosis of epididymitis, he was administered levofloxacin (LVFX) but the fever and painful enlargement persisted. Because of the poor response to antimicrobial agents and the undeniable complications of testicular malignancy, radical orchiectomy was performed. The testis was enlarged to 7cm, weighed approximately 100g, and was filled with pus. A substantial portion of the tumor was seminoma, and pus culture revealed Salmonella saintpaul. Although testicular tumors are the most common differential diseases for testicular abscess, there are few reports of testicular abscess accompanying testicular tumors. Here, we report a case of testicular seminoma with testicular abscess caused by Salmonella saintpaul.

A CROSS-SECTIONAL STUDY TO ASSESS CLINICO-EPIDEMIOLOGICAL FACTORS, DIAGNOSIS AND MANAGEMENT IN PATIENTS WITH ACUTE SCROTAL CONDITIONS

Background: Many acute scrotal conditions can present in similar way, Testicular torsion is a true surgical emergency because, the likelihood of testicular salvage decreases, as the duration of torsion increases. Other conditions that present in similar way to testicular torsion include, torsion of appendix testis, epididymo - orchitis, blunt trauma to testis, fournier's gangrene, haematocele, pyocele, etc. Aim: Assessment of clinico-epidemiological factors, diagnosis and management in patients with acute scrotal conditions. Methods: This observational, cross-sectional study was conducted on 75 patients which includes all cases of acute scrotal conditions within age group of 5 years to 70 years presenting to surgery OPD or casualty and getting admitted in a tertiary care centre in eastern part of Maharashtra during the period. Results: In our study acute epididymo-orchitis (46.7%) was the commonest cause of acute scrotal pathology followed by Fourneir's gangrene (24%).Incidence of scrotal cellulitis, pyocele, torsion testis, haematocele, were 9.3%,8%,6.7%, 2.7% respectively. One case each of testicular abscess(1.3%) and testicular tumour (1.3%) were also found. Out of 75 cases, 36 cases (48%) were managed conservatively. In Fournier's gangrene, only debridement was done in 8 cases, multiple debridement with secondary suturing was done in 5 cases, multiple debridement followed by skin grafting was done in 5 case. Scrotal exploration and drainage of testicular abscess was done in 1 case. Scrotal exploration with evacuation of hematoma was done in 2 cases of haematocele. Orchidectomy was done in total of 4 cases in which 3 cases have clinical diagnosis of testicular torsion and one case of testicular tumour. Also orchidectomy with contralateral orchidopexy was done in 2 cases of testicular torsion. Conclusion: The most common cause of acute scrotum was epididymo - orchitis which can be managed conservatively. Early exploration can salvage the testis in cases torsion of testis.

Clinicopathological Study of Testicular Lesions in a Tertiary Care Centre of Dakshina Kannada, India

Introduction: Testicular biopsies are performed for both diagnostic and therapeutic purposes. Diagnostic testicular biopsies are usually performed as a part of a male infertility work-up. Therapeutic testicular excision biopsies are performed for a wide range of disorders, including neoplastic lesions, inflammatory lesions, cryptorchidism, testicular trauma, and as a part of prophylactic treatment of carcinoma prostate. Aim: To evaluate the indications for orchidectomy and diagnostic testicular biopsies and to understand the histopathological spectrum of testicular lesions and concordance with clinical diagnosis. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India. The study period is from July 2017 to June 2020. Data was collected and analysed in August 2020. All testis’ biopsies, including excision and diagnostic biopsies, are included in the study. Histopathological findings and the clinical diagnosis were evaluated for concordance. Data were tabulated and statistically evaluated for age distribution, laterality, and frequency using Microsoft Excel 2021. Percentages for the variables and concordance rate were calculated. Results: A total of 139 cases (mean age 54.5 years) were included in the study. Prophylactic orchidectomy for carcinoma prostate (64/139=46.04%) was the most common clinical indication. Non neoplastic lesions account for 48.20% (67/139). Frequent non neoplastic lesions are testicular torsion (23/139=16.55%) and abscess (12/139=8.63%), followed by cryptorchidism (9/139=6.47%). Left-sided lesions are more frequent than right-sided lesions. Histopathology confirmed two cases of suspected male infertility and Androgen Insensitivity Syndrome (AIS). Neoplastic lesion accounts to 6.47% (9/139). Frequent neoplasm in the study was seminoma (3/139=2.16%), followed by lymphoma (2/139=1.44%). Other neoplasms included in the study were mixed germ cell tumours, post-pubertal teratoma, and spermatocytic tumour. Testicular tuberculosis accounts to 1.44% (2/139) in the present population. Conclusion: Non neoplastic lesions were common compared to testicular neoplasms. Testicular torsion, followed by abscess, was the most common indication for orchidectomy. Testicular Tuberculosis can mimic a neoplasm on clinical and radiological work-up. Hence, careful evaluation has to be performed in young suspected cases of tuberculosis.

TUBERCULAR TESTICULAR ABSCESS: A CASE REPORT

Objective: This study aims to provide fellow physicians a better insight in diagnosing and managing similar cases. Case(s) Presentation: A 36 year old male presented to the emergency department with a chief complaint of red, painful, and progressively enlarging swelling of the left scrotal pouch since 1 week ago. The patient had a history of similar complaint and recurrent cloudy urine which were left untreated 1 year before. Based on physical examination and ultrasonography findings, the patient was diagnosed with left scrotal abscess and was treated by incisional drainage of abscess and necrotomy debridement under spinal anesthesia. Discussion: Tuberculosis infection of scrotal contents is rare and occurs in approximately 7% of the patients with tuberculosis, although tuberculosis itself is a global epidemic with more than 2 billion of the world population infected. In patients with genital tuberculosis, pulmonary and renal tuberculosis can be documented in 50% and 80-85% respectively. It is often secondary to the pre-existing tuberculosis of the urinary tract, which may be confirmed by the culture of early morning urine specimens. Conclusion: Treatment of testicular abscess is administration of appropriate antibiotics according to its causative organism accompanied by surgical drainage. Early diagnosis and prompt treatment of testicular abscess is necessary, since chronic and severe cases, as happened in this patient, usually resulted in nonviable testicular tissue and necessitate orchidectomy. This may be due to cumulative ischemia of the testicles from multiple mechanisms: inflammatory infiltration causing compression of the spermatic cord, thrombosis secondary to venous congestion and/or bacterial exotoxins.

To Evaluate the Management of Epididymo-Orchitis at Tertiary Care Hospital

Introduction: Epididymo-orchitis is common condition in scrotum found in surgical practice. It is commonly seen in young males. It can occur at any age. The common age is between 2nd to 4th decades of life. Its duration of illness is 6 weeks in acute condition and 12 weeks in in chronic conditions. It mostly occurs associated with sexually transmitted diseases. Chlamydia trachomatis and Neisseria gonorrhea are the common causative organisms. After age 40, the common organisms causing this disease are Escherichia Coli and Coliform bacteria found on G.I.T. There are also other causes of this disease. It is mostly managed conservatively but it can be operated it the condition develops complications. Even Orchidectomy is also done in some conditions. Objective: To evaluate the management options in epididymo-orchitis . Material methods: This is a cross sectional study done at surgical Unit 1 of Peoples Medical Hospital (PMCH) Nawabshah. The duration of study was one year from 10th August 2019 to 9th July 2020. All the patients were admitted through Surgical out Patient Department (SOPD) and emergency department of Peoples Medical College Hospital (PMCH) Nawabshah. Approval of study was taken from Ethical committee. Detailed history and thorough clinical examination was done. Routine investigations were done apart from viral markers including HIV. Urine DR and Culture ,Ultrasound of Scrotum and CT Scan were done. Management was planned accordingly. Results: Total 65 patients were included in this study. Of them, 20 (31%) had left sided pathology, 40 (61%) had right sided and 5(8%) had bilateral. Testicular abscess formation was seen in 8 (12.3%) patients. In 2 (3.07%) patients, testicular infarction was noted. 1 (1.5%) patient became infertile due to bilateral involvement. 3 (4.6%) patients had developed psychosis. Conclusion: It is concluded that most of the patients were treated conservatively and in a few patients, incision drainage and orchidectomy was performed. Keywords: Epididymo-orchitis. Neiserria Gononrhea, E.Coli, Incision Drainage, Orchidectomy.

160 Emphysematous Epididymo-Orchitis: Is Imaging Critical in Active Management? Case Report and Literature Review

Abstract We hereby present a case report regarding a rare cause of acute scrotum secondary to emphysematous epididymo-orchitis (EEO), often not diagnosed until it reaches an advanced stage, when it becomes a clinical diagnosis with crepitus palpable in scrotal wall with cellulitis. This case report details a 55-year-old man with poorly controlled diabetes who presented with an acute scrotum that failed to resolve with oral antibiotics in primary care. Following rapid detection of EEO on an early scrotal ultrasound scan, the patient had surgical debridement and a near-total orchidectomy with only a small stump of testis and tunica albuginea left behind. This highlights the importance of timely imaging in diabetic men with an acute scrotum following a high clinical suspicion of testicular abscess and an incidental, rare but significant finding of the complication of EEO, as both but particularly the latter would warrant early surgical intervention to prevent a catastrophic sequela: Fournier’s gangrene. This case report also emphasises that as clinicians, we should have a high index of suspicion for local complications and low threshold for intervention in patients with epididymo-orchitis refractory to adequate period of treatment with oral antibiotics (1–2 weeks), particularly in immuno-compromised and poorly controlled diabetics.

A Man With Testicular Pain

An 86-year-old male with a history of diabetes presented to the emergency department (ED) with left testicular pain for 2 days. Physical examination demonstrated an uncircumcised male with a normal testicular lie, left testicle enlargement, erythema, and tenderness to palpation. The patient was afebrile, with a WBC count of 9,000 cells/uL, and urinalysis revealed leukocytes. ED point-of-care ultrasonography was obtained (Figures 1 and 2).Figure 2Sonographic image of the left testicle in the sagittal plane obtained with a high frequency linear transducer demonstrated a hypoechoic structure (arrow) with increased surrounding vascular flow demonstrating inflammatory changes (star) within the testicle. Scrotal wall thickening was seen (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Testicular abscess. Testicular abscess on ultrasonography is typically spherical or elliptical, with a focal area of mixed echogenicity due to necrotic cellular debris.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,2O’Rourke K. Kibbee N. Stubbs A. Ultrasound for the evaluation of skin and soft tissue infections.Mo Med. 2015; 112: 202-205PubMed Google Scholar Testicular abscess may also demonstrate enlargement of the affected testicle and a reactive hydrocele. Testicular abscess is rare and typically results from untreated or severe epididymo-orchitis. In sexually active patients, common pathogens include Neisseria gonorrhea and Chlamydia trachomatis. However, those who are not sexually active can have other gram-negative and gram-positive organisms.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,3Mevorach R.A. Lerner R.M. Dvoretsky P.M. et al.Testicular abscess: diagnosis by ultrasonography.J Urol. 1986; 136: 1213-1216Crossref PubMed Google Scholar,4Hackett B. Sletten Z. Bridwell R.E. Testicular abscess and ischemia secondary to epididymo-orchitis.Cureus. 2020; 12e8991PubMed Google Scholar Typically, patients will report testicular pain, swelling, and fever. The differential diagnosis includes testicular torsion, epididyomo-orchitis, epididymal abscess, testicular cancer, and testicular trauma. Ultrasound is the initial imaging modality needed to differentiate testicular abscess from other similarly presenting diagnoses. Treatment depends on the size of the testicular abscess and clinical parameters. Minor cases (those in patients who have normal WBC counts, are afebrile, are able to urinate, and do not have signs of necrotizing fasciitis) can be treated with antibiotics, while more severe cases may require surgical debridement or orchiectomy. ED treatment includes initiation of antibiotic therapy and urology consultation.

Microlitiasis testicular una patología rara y poco conocida. Reporte de casos y revisión de literatura

Objetivo: El objetivo del presente trabajo es hacer una revisión de los casos reportados por ultrasonido de microlitiasis testicular y hacer una revisión de la literatura.
 Diseño: Se realizó una revisión de los ultrasonidos testiculares en los que se reportó microlitiasis testicular en el periodo comprendido del 2011 a 2018 en el Hospital “Dr. Manuel Gea González”, las variables que se analizaron fueron: edad, motivo del estudio, lado afectado y otros hallazgos.
 Resultados: Fueron 21 ultrasonidos con microlitiasis testicular con rango de edad de 6 a 24 años con promedio de 16 años. En el 81% afecto a ambos testículos, y en el 29% afecto el lado izquierdo. En el motivo del estudio el dolor testicular se encontró en el 33 % (7 casos), 14 % por tumor testicular (3 casos), torsión testicular 10% (2 casos), otras causas fueron varicocele, absceso y trauma testiculares.
 Limitaciones del estudio: Al tratarse de un estudio observacional retrospectivo, las conclusiones obtenidas son relativas.
 Originalidad: La microlitiasis tiene una prevalencia informada entre el 2.4% y el 3.8% en niños, se asocia a neoplasias testiculares y puede causar infertilidad. Se considera como posible etiología algunas nanobacterias que inducen las calcificaciones testiculares por lo tanto el estudio de esta patología podría modificar su tratamiento y prevenir su aparición. 
 Conclusiones: La microlitiasis testicular es una patología rara y poco conocida que puede estar asociada a cáncer e infertilidad y al parecer su etiología puede ser infecciosa ocasionada por nanobacterias. Es una patología abierta a la investigación.

Testicular microlithiasis, a rare and little-known disease: Case reports and a literature review

Objective: The aim of the present work was to review the cases of testicular microlithiasis revealed by ultrasound and carry out a review of the literature.
 Design: Testicular ultrasounds that identified testicular microlithiasis in patients seen at the Hospital “Dr. Manuel Gea González”, within the time frame of 2011 and 2018, were reviewed. Age, study indication, and laterality were among the variables analyzed.
 Results: Twenty-one ultrasounds revealed testicular microlithiasis in patients ranging from 6 to 24 years of age, with a mean of 16 years. Both testes were affected in 81% of the patients, and the left testis was affected in 29%. The indication for ultrasound was testicular pain in 33% (7 cases), testicular tumor in 14% (3 cases), and testicular torsion in 10% (2 cases). Other causes were varicocele, testicular abscess, and testicular trauma.
 Study limitations: The conclusions were relative, given the study’s retrospective, observational design. 
 Originality: Microlithiasis has a reported prevalence of 2.4% to 3.8% in children. It is associated with testicular tumors and can cause infertility. A possible cause is nanobacteria that induce testicular calcifications. The study of the disease could modify its treatment and prevent its appearance. 
 Conclusions: Testicular microlithiasis is a rare and little-known disease that can be associated with cancer and infertility. Its etiology appears to be nanobacterial infection. More research on the disease should be carried out.

An Evaluation of Abdominal Manifestations by Ultrasonography in Immunodeficiency Patients

Introduction: The major target of HIV is the immune system and the abdominal pathologies are second most commonly found in patients of AIDS after pulmonary manifestations. These abdominal manifestations are on increase may be due to immunocompromised status of these patients and due to antiretroviral therapy which has increased life expectancy in these patients. Purpose of this study is to describe abdominal findings and to evaluate clinical utility of USG in HIV patients with the use of abdominal probe, high frequency probe and Color Doppler USG. Methods: This Retrospective Analytical study involved 60 randomly selected HIV patients attending to Local ART Units . Prior Consent was obtained from Local ART Centre to see the records of the patients from there MRD .Patients of all age groups and both sex having cataract were included in the study Results: This study includes 60 HIV patients, 37 patients were male and 23 patients were female. Age group studied was 20 yrs to 65 yrs referred from ART Department . Most prevalent age group was from 40 - 49 yrs that was 23 patients, next was 30 - 39 yrs i.e. 20 patients, third in declining order was 20 - 29 yrs i.e. 12 patients and less prevalent age groups were from 50 - 59 yrs and above 60 - 70 yrs. These patients had diverse abdominal findings. Out of 60 patients 3 had no abdominal findings. Hepatomegaly was found in 33 patients, fatty hepatic changes in 14 patients and in one case there was Hepatic abscess. Lymphadenopathy was found in 28 cases. Splenomegaly was found in 20 cases and in 6 cases there were also having splenic abscesses. Ascites was found in 12 cases it was septated and non septated ascites. Cholecystitis in 4 cases. Bowel wall thickening in 5 cases in most of cases it was thickening of ileum and Ileocaecal junction thickening. Other findings were renal parenchymal disease in 2 cases, Bulky pancreas in 2 cases, cervicitis in 2 cases, one case each of cystitis and pyocele. Testicular abscess in 2 cases and gluteal abscess in one case along with other abdominal findings. Many patients had two or more pathologies. Conclusion: AIDS is multisystem disease but its demographic and clinical pattern remains same globally. USG is optimally suited for its clinical management especially in developing countries like India. Results of sonographically evaluated cases of abdominal findings are comparable to other diagnostic modalities like CT scan. The ease of availability, diagnostic accuracy of USG and its affordable cost and interventional and follow up advantages makes USG first choice of investigation for evaluation of abdominal findings. Clinico-pathological correlations can further increase its diagnostic accuracy.

Rickettsial epididymo-orchitis – An emerging threat in endemic areas

Introduction: Rickettsial infections are reemerging infections in various parts of the world. Although there can be protean manifestations of rickettsial infection, epididymo-orchitis is by far uncommon. Materials and Methods: Fifty patients with a mean age of 35.1 (17–67) years with signs and symptoms suggestive of acute epididymo-orchitis were evaluated and 15 of these positive for Weil–Felix Reaction were included in the study after ruling out the common causes of epididymo-orchitis. Results: Fifteen patients had positive Weil–Felix reaction and were considered to have rickettsial epididymo-orchitis. Seven patients had right, 5 had left, while 3 had bilateral epididymo-orchitis. Most of the patients presented within 2 weeks of onset of symptoms. Five patients were positive for OX2, four patients were positive for OXK titers, four for OX19 and OX2, while two were positive for OX19 Weil–Felix reaction. These patients were started on doxycycline 100 mg bd for 7 days and followed up. In the follow-up, none of them developed complications of testicular abscess or chronic epididymo-orchitis. Conclusion: Rickettsial epididymo-orchitis is a very rare entity and it as an emerging threat in endemic areas. We strongly recommend that in the areas endemic for Rickettsia, all cases of epidiymo-orchitis should be evaluated for the presence of rickettsial infection, as early identification of such an infection would lead to prompt and precise management.

Ruptured Testicular Abscess: A Rare Complication of Epididymo-Orchitis

Epididymo-orchitis is a medical condition characterised by inflammation of epididymis and testis which is a common urological diagnosis encountered by healthcare professionals. Misdiagnosis and under treatment can lead to poor outcome such as infarction and abscess formation. We presented a 33-year-old man, with no known medical illness, presented with one-week history of left testicular pain, swelling and fever. He was commenced on Amoxicillin by his general practitioner. Physical examination showed left swollen and tender testis and normal right testis. Investigations showed an elevated white cell count (WCC) 41.3x103 /L and colour doppler ultrasound (USG) testes showed left epididymo-orhitis. He was admitted and treated with IV Unasyn® (Ampicillin+Sulbactam) for 5 days. His symptoms improved, and he discharged home well with one week oral Unasyn®. He represented 2 weeks later with worsening left scrotal swelling and pain. Clinical examination found a swollen, tender and erythematous scrotum with 1x1cm defect in the left scrotum with purulent discharge. He underwent operation incision and drainage of left scrotum and left orchidectomy. Post-operatively he recovered well. Histopathology reported as epididimoorchitis with abscess, necrosis and perforation. As a conclusion, testicular rupture and abscess formation secondary to epididymo-orchitis is an uncommon reported complication. Immediate recognition and treatment is crucial as a delayed diagnosis can lead to sepsis and infertility.

025 Conservative Management of Testicular Abscesses with Oral Antibiotics: Report of a Case Series

025 Conservative Management of Testicular Abscesses with Oral Antibiotics: Report of a Case Series