A Personal Problem – The Case of the Swollen Scrotum

Author: Yasmin Sultan / Editor: Adrian Boyle / Reviewer: Michael Perry, Srikanth Padmanabhan / Codes: / Published: 17/01/2023

A 45-year-old man attends the Emergency Department (ED) with a presenting complaint of a “personal problem”. He gives a 3 day history of scrotal discomfort. Today his scrotum has become very swollen and the skin is red and tender. He has not had a fever, but for the last 24 hours he has had frequent loose stools. This morning he saw his GP, who prescribed ibuprofen and booked an ultrasound scan. However, the pain has increased (he describes it as a burning sensation), so he is requesting a topical analgesic cream.

He has never experienced scrotal swelling before, has no past medical history and is on no regular medications.

On examination, he is obese, sweaty, appears anxious and pacing around the waiting room. He explains that he is unable to sit due to his scrotal discomfort and is apprehensive of hospitals. His temperature is 35.7oC, heart rate 105 beats per minute, BP 140/80, RR 14, oxygen saturations 98% on air and pain score 5/10. His scrotal appearance is shown. The skin appears oedematous and is generally tender. You are unable to palpate the testes through the tensely swollen scrotum. There is no crepitus and no groin lymphadenopathy. The scrotum does not transilluminate and is not fluctuant.

You wonder whether he could have necrotizing fasciitis.

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