Scrotal Abscess

53

• Collection of pus within the scrotum.

• Can be superficial and 'tent' the scrotal skin.
• Deep infections within the scrotum (testicular) can also result in
deep seated abcess.
• Check for underlying testicular tumours (Arias -Cameron).
Definition • It can also mimick torsion (Toh).

• Risk factors: structurally abnormal urinary tract: diabetes,

immunosuppression, smoking.
• Epididymitis, if necrotising.
• Testicular abcess.
• Delayed torsion.
• Testicular Tumour.
Causes • Patent processus vaginalis and appendicitis.

• Painful area, with no relief, often fluctuant having increased in size.

• Features of abcess: Callor-warmth, Rubor-redness, Dolor -pain,
Tumour-mass.
• Fevers/ rigors/ LUTS/ UTIS.
• History of recurrent abcesses, or diabetes, post surgery.
History • An USS is require for diagnosis (Miskin).

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146 53  Scrotal Abscess

• Abdomen and perineum: area of skin discolouration (mark area),

• Erythema, swelling, redness present.
• Fluctuant lesion, tender to touch.
• Check no crepitus present (necrotising fasciitis)
• Assess the abdomen,? tender in RIF? appendicitis, palpable
Examination bladder?

• Urine analysis and culture.

• Bloods: FBS, clotting renal function and LFTS.
• Pus swab if abcess burst.

Investigations

• Keep patient NBM, give IV abx.

• Take patient to theater for incision and drainage of abcess.
• Use a yates drain to keep the abcess open-remove on the ward
the next day.
• Scrotal abcesses are superficial and do not normally require
Outcome packing.

Suggested Reading
Arias-Camison JM, Desilva HN, Panthagani I, Twohig MT, Bourque MD. Scrotal abcess mimick-
ing testicular torsion in a premature infant. Conn Med. 2009;73(4):215–6.
Miskin M, Buckspan M, Bain J.  Ultrasonographic examination of scrotal masses. J Urol.
1977;117(2):185–8.
Toh JW, Gibson K, Vanlioglu B, Ang S, Ong E.  Rapid progression of perianal abscess into
Fournier’s gangrene. ANZ J Surg. 2015;85(3):192–3.