Saleem Muhammad Mudasir, Pervaiz Mishal, Mazhar Ismail, Shoaib Uswah, Rafique Muhammad Umar
Paediatrics and General Surgery, Combined Military Hospital, Lahore, Pakistan.
Department of Anaesthesiology, Punjab Rangers Teaching Hospital Lahore, Pakistan.
Discoveries (Craiova). 2025 Jun 30;13(1):e210. doi: 10.15190/d.2025.9. eCollection 2025 Apr-Jun.
Acute scrotum in neonates is a rare condition with multiple causes, including incarcerated hernia, testicular torsion, birth trauma, gross hydrocele, and neonatal adrenal haemorrhage, the least common aetiology. Early diagnosis and intervention are essential to prevent testicular ischemia. Due to the continuity between the retroperitoneum and the scrotum via the processus vaginalis and inguinal canal, blood from an adrenal haemorrhage may track down into the scrotum, leading to swelling and discoloration. We report a case of a 1-day-old male neonate born via emergency caesarean section at 37 weeks due to foetal distress. The baby initially admitted to the NICU for transient tachypnoea, developed a right hemi-scrotal swelling with bluish discoloration on the second day of life. Scrotal ultrasound suggested testicular torsion, but Doppler imaging showed absent blood flow. Further abdominal ultrasound confirmed a right adrenal haemorrhage. The neonate was managed conservatively with intravenous fluids, antibiotics, oxygen support, and coagulation management. Serial ultrasounds showed gradual resolution, and he was discharged on the 17th postnatal day. Follow-up at 1 and 3 months showed complete recovery with normal growth. Neonatal adrenal haemorrhage should be considered in cases of acute scrotum, especially in neonates with birth asphyxia. Abdominal ultrasound can aid in diagnosis, preventing diagnostic delays, unnecessary surgery, and anaesthesia exposure. This case highlights the importance of thorough imaging and awareness of rare differential diagnoses, contributing to improved clinical practice and better neonatal outcomes.
新生儿急性阴囊是一种病因多样的罕见病症，包括嵌顿疝、睾丸扭转、产伤、巨大鞘膜积液和新生儿肾上腺出血（最不常见的病因）。早期诊断和干预对于预防睾丸缺血至关重要。由于腹膜后间隙与阴囊通过鞘突和腹股沟管相连，肾上腺出血的血液可能会向下流入阴囊，导致肿胀和变色。我们报告一例1日龄男性新生儿，因胎儿窘迫在37周时通过急诊剖宫产出生。该婴儿最初因短暂性呼吸急促入住新生儿重症监护病房，出生第二天出现右侧阴囊肿胀并伴有青紫变色。阴囊超声提示睾丸扭转，但多普勒成像显示无血流信号。进一步的腹部超声证实右侧肾上腺出血。该新生儿接受了静脉补液、抗生素治疗、氧气支持和凝血管理等保守治疗。系列超声检查显示病情逐渐缓解，出生后第17天出院。1个月和3个月的随访显示完全恢复且生长正常。对于急性阴囊病例，尤其是有出生窒息的新生儿，应考虑新生儿肾上腺出血。腹部超声有助于诊断，可避免诊断延迟、不必要的手术和麻醉暴露。本病例突出了全面影像学检查以及对罕见鉴别诊断的认识的重要性，有助于改善临床实践并提高新生儿预后。
