RARE COMPLICATIONS OF EPIDIDYMITIS; A REPORT OF TWO RECENT CASES
By Emmanuel Abiola Babington, University Hospitals of Leicester NHS Trust
Background:
Epididymitis is a common condition in the emergency department, usually treated with antibiotic therapy. Complications of severe epididymitis are uncommon but can include abscess formation and testicular necrosis. We present two recently encountered cases of severe complications of epididymitis in our department.
Case Summary:
Case 1: A 49-year-old male presented with a sudden onset of severe pain, swelling, hardness, and tenderness in the left hemiscrotum, with a history of treated left epididymitis 13 months ago. Ultrasound revealed evidence of left epididymitis affecting the left epididymal tail, some reactive left hydrocoele and normal-appearing testes. After eight days of ongoing antibiotic therapy, the patient presented with deteriorating symptoms. A second ultrasound revealed worsening left epididymitis with a new onset of an avascular left testis. A third ultrasound done twelve days later confirmed left testicular necrosis secondary to severe epididymitis. The patient had a left orchidectomy, and subsequent histology confirmed the ultrasound findings.
Case 2: A 46-year-old male presented with a swollen and significantly tender right hemiscrotum. Ultrasound revealed a bulky, heterogeneous, hyperemic right epididymis with normal right testicular vascularity. Ten days later, the patient presented with worsening right hemiscrotal symptoms despite commencing antibiotic therapy. A second ultrasound revealed the ongoing right epididymitis with a heterogeneous and avascular right testis, but no scrotal collection was seen. However, an ultrasound three weeks later revealed the presence of a 38 mm x 25 mm x 30 mm (L x AP x T) cystic collection with some focal debris and thick-walled septations in the right hemiscrotum, suggestive of an abscess.
Discussion:
Ultrasound is an efficient diagnostic modality for examining the testes for epididymitis and its potential complications. Our cases reveal the prognosis of severe epididymitis. Some authors believe there are ultrasound features that might predict an impending testicular necrosis; however, further research is needed in this area.