The Johns Hopkins University School of Medicine, 733 N Broadway St., Baltimore, MD 21205, USA.
Department of Emergency Medicine, The Johns Hopkins Hospital, 1800 Orleans Street Sheikh Zayed 1, Room 1085, Baltimore, MD 21287, USA.
Am J Emerg Med. 2023 May;67:48-50. doi: 10.1016/j.ajem.2023.01.051. Epub 2023 Feb 9.
We describe the common presenting signs and symptoms, treatment modalities, and outcomes of acutely presenting scrotal pyoceles.
We conducted a retrospective chart review of all adult patients treated for ultrasound-confirmed scrotal pyoceles between 2010 and 2020 at two sites within the [redacted]. Vitals at presentation, microbiology, and inpatient courses including antibiotic treatment and surgical procedures were collected.
A total of 360 scrotal ultrasounds were reviewed identifying 15 patients with pyoceles, 11 patients presenting to the emergency department and 4 hospitalized patients. The most common chief complaint was testicular pain (67%). Only seven patients (47%) met SIRS criteria upon presentation. All patients were initially treated with broad-spectrum antibiotics and observation; 11 (73%) responded to this management alone, while four patients (27%) required surgical drainage due to persistent infection. No patients contracted Fournier's gangrene.
This study reports the largest published database of scrotal pyoceles to date and describes our clinical approach to management. While pyoceles have traditionally been treated aggressively with surgical drainage, this case series suggests that most patients improve with broad-spectrum antibiotic treatment and observation alone, requiring surgical drainage if infection persists. Future investigations including multi-institutional data will be necessary to validate our institution's approach.
我们描述了急性表现的阴囊积脓的常见表现体征、治疗方式和转归。
我们对[隐去的]两家机构在 2010 年至 2020 年间经超声证实为阴囊积脓的所有成年患者进行了回顾性图表审查。收集了就诊时的生命体征、微生物学以及住院期间的治疗过程，包括抗生素治疗和手术。
共对 360 例阴囊超声进行了回顾，发现 15 例患者存在积脓，其中 11 例患者就诊于急诊科，4 例患者住院。最常见的主诉是睾丸疼痛（67%）。仅有 7 名患者（47%）在就诊时符合全身炎症反应综合征（SIRS）标准。所有患者最初均接受广谱抗生素治疗和观察；11 名患者（73%）单独接受这种治疗后得到缓解，而 4 名患者（27%）因持续感染需要手术引流。没有患者发生 Fournier 坏疽。
本研究报告了迄今为止发表的最大的阴囊积脓数据库，并描述了我们对其管理的临床方法。虽然积脓传统上需要积极进行手术引流，但本病例系列表明，大多数患者通过广谱抗生素治疗和单纯观察即可改善，只有在感染持续存在时才需要手术引流。未来的研究，包括多机构数据，将有助于验证我们机构的方法。
