Subramanian Vaidyanathan, Soni Bakul, Hughes Peter, Swindells Mark
Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom.
Department of Radiology, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom.
Radiol Case Rep. 2022 Aug 13;17(10):3938-3945. doi: 10.1016/j.radcr.2022.07.075. eCollection 2022 Oct.
Epididymo-cutaneous fistula was seen in a person with cervical spinal cord injury and neuropathic bladder. This patient developed left epididymitis; then he formed an abscess superficial to the tail of the epididymis, which burst open to the skin discharging pus; subsequently, this progressed to epididymo-cutaneous fistula. A few drops of urine would leak through the fistula. The carers kept a dressing over the fistula to collect the small amount of urine leak and changed the dressing daily. This patient's carers squeezed any subcutaneous collection and drained the pus through the fistula. Serial ultrasound imaging of the scrotum was performed to guide the clinical management: (1) any subcutaneous abscess detected by the ultrasound scan was drained promptly; (2) ultrasound scans confirmed absence of any pathology in the testis; (3) the course of the disease was monitored as chronic epididymitis with echogenic debris in epididymal tail progressed to development of epididymo-cutaneous fistula and later to a chronic fistula with a matured tract. The serial scans revealed thickened tail of the left epididymis with heterogenous echo texture with no abscess formation, which encouraged the continuation of conservative management over a 5-year period while maintaining good quality of life. At the last follow-up in June 2022, leakage of urine from the epididymo-cutaneous fistula was observed very infrequently (once a month).
在一名患有颈脊髓损伤和神经源性膀胱的患者中发现了附睾皮肤瘘。该患者发生了左侧附睾炎；随后，在附睾尾部浅表形成了一个脓肿，脓肿破溃至皮肤并排出脓液；随后，病情发展为附睾皮肤瘘。几滴尿液会通过瘘管渗漏出来。护理人员在瘘管上覆盖敷料以收集少量尿液渗漏，并每天更换敷料。该患者的护理人员挤压任何皮下积液，并通过瘘管引流脓液。对阴囊进行系列超声成像以指导临床管理：（1）超声扫描检测到的任何皮下脓肿均及时引流；（2）超声扫描证实睾丸无任何病变；（3）监测疾病进程，附睾尾部伴有回声性碎屑的慢性附睾炎发展为附睾皮肤瘘，随后发展为具有成熟瘘道的慢性瘘管。系列扫描显示左侧附睾尾部增厚，回声不均匀，无脓肿形成，这促使在5年期间持续进行保守治疗，同时保持良好的生活质量。在2022年6月的最后一次随访中，观察到附睾皮肤瘘的尿液渗漏非常罕见（每月一次）。
