Yasumoto R, Kawano M, Kawanishi H, Shindow K, Hiura A, Kim E, Ikehara T
Department of Urology, Osaka Municipal Juso-shimin Hospital, Japan.
Int J Urol. 1998 Jan;5(1):108-10. doi: 10.1111/j.1442-2042.1998.tb00254.x.
A 10-year-old boy, who had a mild inguinal hernia in his left scrotum, was referred to our clinic because of redness of the scrotal skin and tenderness of the left scrotal contents. Scrotal echography showed a hypoechoic lesion around the normal testis and epididymis. Because torsion of either the testis or testicular appendage was suspected, the scrotum was opened and 1.5 mL of purulent fluid was observed in the tunica vaginalis with inflammatory tissue around the testis and epididymis. On the first postoperative day, a low grade fever and abdominal tenderness persisted, however, the abdomen was flat and soft. There was no marked tenderness over McBurney's point, but there was moderate tenderness over Lanz's point on deep palpation. Abdominal sonography and magnetic resonance imaging revealed abscess formation between the bladder and the sacrum. With a diagnosis of perforation of the appendix, a laparotomy was performed. The inguinal hernia sac could not be observed on inspection, and it was not possible to palpate the left side because of severe adhesion due to infection. Also, the neck of the right inguinal sac could not be seen. The appendix specimen was gangrenous. On the second postsurgical day, all symptoms and signs disappeared. We present this rare condition and discuss the difficulty in establishing a diagnosis.
一名10岁男孩，左侧阴囊有轻度腹股沟疝，因阴囊皮肤发红及左侧阴囊内容物压痛而转诊至我院。阴囊超声检查显示正常睾丸和附睾周围有低回声病变。由于怀疑睾丸或睾丸附件扭转，遂打开阴囊，在鞘膜腔内观察到1.5毫升脓性液体，睾丸和附睾周围有炎性组织。术后第一天，低热和腹部压痛持续存在，但腹部平坦柔软。麦氏点无明显压痛，但深触诊时兰氏点有中度压痛。腹部超声和磁共振成像显示膀胱与骶骨之间有脓肿形成。诊断为阑尾穿孔，遂行剖腹手术。检查时未观察到腹股沟疝囊，由于感染导致严重粘连，无法触及左侧。此外，右侧腹股沟疝囊颈部也未见。阑尾标本已坏疽。术后第二天，所有症状和体征均消失。我们报告这种罕见情况并讨论诊断的困难。
