Clinical Study on Acute Inflammatory Inguinoscrotal Lesions

ABSTRACT

Introduction: Acute inguinoscrotal swellings are the most common swellings affecting both children and adults.Although these swellings are frequently encountered, many times correct diagnosis is not made and testes have beensacrificed. A wide variety of acute inflammatory conditions affects inguinoscrotal region and testes such as inguinalabscess, funiculitis, inguinal lymphadenitis, primary infections of scrotum, and/or secondary infection of testes such asepididymo-orchitis and scrotal abscess, pyocele, and Fournier’s gangrene. Knowledge of the risk factors, prevention,and early detection with prompt treatment of inguinoscrotal lesions, which leads to reduction in morbidity and mortalityassociated with these lesions.Materials and Methods: In this prospective study carried out in 195 patients in the Department of Surgery, Shyam ShahMedical College and associated Gandhi Memorial and Sanjay Gandhi Memorial Hospitals, Rewa, Madhya Pradesh, during theperiod of 1 June 2017 to 31 May 2018. All male patients with complaints of acute painful inguinoscrotal swelling and ulcer witha history of <2 weeks were included in the study. Presenting complaints and detailed history were recorded in a predesignedpro forma. Thorough general examination and local examination were done. Patients were investigated and final diagnosiswas established. Then, treatment was initiated according to diagnosis.Results: Acute epididymo-orchitis (42.6%) was the most common cause for acute inguinoscrotal pathology followed byFournier’s gangrene (19.5%) and scrotal abscess (17.9%). Majority patients belong to the age group of 31–40 years, 22.6%and in the age group of 41–50 years, 20.5%. The most common predisposing factor was lower urinary tract syndrome presentin 47.1% followed by poor personal hygiene (43.07%). Conservative treatment was given in 80 patients. All, except eight casesof epididymo-orchitis (83), two cases of scrotal cellulitis and four cases of inguinal lymphadenitis were treated conservatively.All 38 cases of Fournier’s gangrene and one case of scrotal cellulitis were treated by debridement and daily dressings. Incisionand drainage of pyocele was carried out in five patients. Scrotal exploration with drainage of testicular abscess was done inthree cases. Orchidectomy was required in two cases of testicular abscess.Conclusion: Acute inguinoscrotal lesions are common in younger and middle age individuals with variable symptomatology.Such conditions presenting to emergency department need careful examination, proper evaluation, and prompt treatment.Conservative treatment with rest, scrotal support, antibiotics, and analgesics is effective in case of epididymo-orchitis.Emergency surgical exploration proved to be the best in case of scrotal abscess, Fournier’s gangrene, pyocele, andhematocele. Various predisposing factors can be minimized by proper health education and developing good primary healthcare system.