The patient had an acute onset of scrotal pain during his vacation in a foreign country. An ultrasound examination in a foreign hospital showed an abnormality that the doctors there wanted to operate immediately. The parents, however, decided to have the child operated in their own country and drove back immediately by car. After 24 hours the ultrasound examination was repeated in their home town. Was it a good idea of the parents to ignore the foreign doctors advise?
In a case of an acute onset of scrotal pain one should always think about a testicular torsion. If the first boy had had a testicular torsion, it would have been very unwise to postpone the operation. However, although the testis and epididymis were swollen there was not a tesicular torsion. There was a scrotal hernia with herniated fatty tissue. This had become partially infarcted leading to swelling and this resulted in diminished flow in the testis and epididymis with swelling as a result At the time of the second examination 24 hours later the pain had diminished a bit but there was still some swelling. However, the flow in the testis was normal. The infarcted part of the fatty tissue was clearly visible. The surgeon decided not to operate immediately. A week later the swelling was gone and the patient was operated The diagnosis scrotal hernia with partially infarcted fatty tissue was confirmed. Testis and epididymis were completely normal. The second patient also had a scotal hernia. There was an incarcerated bowel loop that needed immediate surgery
Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.
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