TÇCD 2011 29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

AIM: Intraabdominal infectious complications in the form of abscess formation following appendicectomy in children are well recognized.  An acute scrotum occurring postoperatively in a patient with appendicitis is a rare complication.

METHOD: An unusual case of a twelve-year-old with scrotal suppuration on day 3 following appendicectomy is described and relevant cases reported in the literature are reviewed.

RESULTS: A comprehensive literature review yielded eight studies reporting on twelve boys of 4 to 15 years of age with acute scrotum following appendicitis.  At the time of appendicectomy eleven children were found to have a perforated appendix while two had acute appendicitis. Open and laparoscopic appendicectomies were carried out in eleven and two children respectively. Acute scrotal manifestations occurred between two and ten days postoperatively and involved the right hemiscrotum in nine children or the left hemiscrotum in four children. Exploration was performed via a groin incision in all patients. A patent proceccus vaginalis (PPV) or a hernial sac was identified in eight children while in the remaining four children a PPV was either not visualised or not present.  One case of a three-year-old girl with inguinal and labial suppuration following appendicectomy has also been reported. The outcome was good in all cases except for one ten-year-old boy who had an orchiectomy due to a non viable testis at the time of groin exploration.

CONCLUSIONS: Scrotal inflammation complicating appendicitis should be considered in the differential diagnosis of acute scrotum presenting after appendicectomy in children. In cases of acute scrotal symptoms and signs patients should be explored early to avoid the risk of testicular loss.

AIM: Intraabdominal infectious complications in the form of abscess formation following appendicectomy in children are well recognized.  An acute scrotum occurring postoperatively in a patient with appendicitis is a rare complication.

METHOD: An unusual case of a twelve-year-old with scrotal suppuration on day 3 following appendicectomy is described and relevant cases reported in the literature are reviewed.

RESULTS: A comprehensive literature review yielded eight studies reporting on twelve boys of 4 to 15 years of age with acute scrotum following appendicitis.  At the time of appendicectomy eleven children were found to have a perforated appendix while two had acute appendicitis. Open and laparoscopic appendicectomies were carried out in eleven and two children respectively. Acute scrotal manifestations occurred between two and ten days postoperatively and involved the right hemiscrotum in nine children or the left hemiscrotum in four children. Exploration was performed via a groin incision in all patients. A patent proceccus vaginalis (PPV) or a hernial sac was identified in eight children while in the remaining four children a PPV was either not visualised or not present.  One case of a three-year-old girl with inguinal and labial suppuration following appendicectomy has also been reported. The outcome was good in all cases except for one ten-year-old boy who had an orchiectomy due to a non viable testis at the time of groin exploration.

CONCLUSIONS: Scrotal inflammation complicating appendicitis should be considered in the differential diagnosis of acute scrotum presenting after appendicectomy in children. In cases of acute scrotal symptoms and signs patients should be explored early to avoid the risk of testicular loss.