A Rare Case of Epididymal Abscess in an Infant Treated Successfully with Needle Aspiration.

A 5-month-old boy presented with right scrotal swelling. Color Doppler ultrasonography showed an encapsulated hypoechoic lesion with surrounding hyperemia in the right tail of the epididymis. We performed surgical exploration of the scrotum because it was not considered to be a typical epididymitis. During the operation, we aspirated pus from his right epididymis through a needle by referring to the color Doppler findings. This is the first case of epididymal abscess in an infant to be successfully diagnosed and treated with needle aspiration.

Introduction

Epididymitis is an important clinical syndrome because of its differential diagnosis and management. Epididymitis is often difficult to distinguish from other pediatric acute scrotal pathologies, especially acute testicular torsion. When a boy has an acute scrotal condition, it is useful to confirm epididymitis by using scrotal color Doppler ultrasonography. We report a rare case of epididymal abscess in an infant that was diagnosed and treated successfully with needle aspiration.

Case presentation

A 5-month-old boy presented with right scrotal swelling. Physical examination revealed an enlarged, reddish right scrotum. Urine obtained via urethral catheterization showed pyuria. Hematology tests revealed a leukocyte count and C-reactive protein level of 16,200/μL and 2.97 mg/dL, respectively. Abdominal ultrasonography did not reveal an ectopic ureter, a prostatic utricle, or a high residual volume of urine. Color Doppler ultrasonography demonstrated an encapsulated hypoechoic lesion with surrounding hyperemia in the right tail of the epididymis (Fig. 1). We performed open surgery on the patient, because we could not deny the possibility of acute testicular torsion. Surgical exploration of the scrotum revealed an enlarged tail of the epididymis; therefore, we tapped the enlarged epididymis by referring to the color Doppler findings and pus was aspirated (Fig. 2). Then, we cleaned the surgical wound site and performed orchidopexy. Cefotiam (0.9 g/day) was administered during and after surgery, and Klebsiella pneumoniae sensitive to cefotiam was detected in the pus and urine cultures 3 days after surgery. Three years later, there was no recurrence or urinary tract infection, and no right epididymis or testis atrophy.

Figure 1

Ultrasound image of the right epididymis. Ultrasound reveals a 5-mm hypo-echoic lesion within the tail of the epididymis (arrow). Color Doppler interrogation of the abscess shows peripheral hyperemia (arrow head).

Figure 2

Tapping the enlarged epididymis and aspirating pus.

Discussion

Epididymal abscesses are an uncommon complication of epididymitis, which may occur when epididymitis is uncontrolled or untreated and are generally resistant to antibiotics. To our knowledge, there is no report of epididymal abscesses in infants.

Although color Doppler ultrasonography is useful to evaluate scrotal swelling,3, 4 surgical exploration of the scrotum is warranted when the diagnosis remains unclear. We could not completely deny the possibility of acute testicular torsion; therefore, we performed open surgery on the patient. Moreover, we tapped the abscess based on the premise that antibiotics may not work on epididymal abscesses.

We were able to diagnose and treat the epididymal abscess effectively to aspirate the epididymal pus. We believe that needle aspiration of abscesses should be considered as a management option in children with an epididymal abscess.

Conflict of interest

The authors declare no conflict of interest related to the research.