Acute appendicitis masquerading as acute scrotum: a case report

Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review

Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.

Campylobacter jejuni enterocolitis presenting with testicular pain: A case report

BACKGROUND

Common symptoms of Campylobacter colitis include abdominal pain, vomiting, diarrhea, and fever, among others. However, Campylobacter colitis also has a high incidence of extraintestinal symptoms.

CASE SUMMARY

We report the case of a 51-year-old man who presented with bilateral testicular pain. A scrotal examination failed to reveal any physical findings, but the patient exhibited mild tenderness in the right lower abdomen. Computed tomography revealed ileocecal wall thickening. Post-admission, the patient developed diarrhea, and a stool culture was submitted; Campylobacter jejuni infection was confirmed. Testicular pain is known to be caused by appendicitis. Consequently, we suggest that Campylobacter colitis, which causes ileocecal inflammation, caused the testicular pain in this case.

CONCLUSION

In patients with testicular pain and no other objective findings, diseases such as Campylobacter colitis should be considered.

What is beyond testicular torsion and epididymitis? Rare differential diagnoses of acute scrotal pain in adults: A systematic review

Background

Acute scrotal pain is a urological emergency. While for testicular torsion and acute epididymitis clinical recommendations are well established, few is known about low incidence causes of acute scrotal pain. Our aim is to identify and characterise rare differential diagnoses of acute scrotal pain in order to give diagnostic and therapeutic recommendations.

Materials and methods

A systematic literature search was performed in PubMed, Web of Science and the Cochrane Library databases up to February 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The systematic review protocol was registered on PROSPERO (CRD42018099472).

Results

Eighty-four publications were selected for analysis. The databases provided mostly case reports, series and small studies, overall reporting on a cohort of 245 cases. Tumors, segmental testicular infarction, testicular vasculitis, pancreatitis, brucellosis, spermatic vein thrombosis, acute aortic syndrome and appendicitis were identified as rare underlying causes of acute scrotal pain and were characterised. As a result of our data analysis we were able to draw an overview of the rare differential diagnoses and diagnostic management of acute scrotal pain.

Conclusion

Rare differential diagnoses of acute scrotal pain are susceptible to misinterpretation as testicular torsion or acute epididymo-orchitis. Surgical management is indicated in case of suspicion for torsion or tumor. We herein present knowledge of the rare differential diagnoses and raise awareness for associated systemic disease in order to facilitate disease management and increase the potential for testicle-sparing treatment.

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First systematic approach to assess literature for rare differential diagnoses of acute scrotal pain.

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Disease characterization including sonographic features.

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Flow chart for the diagnostic and treatment options of acute scrotal pain beyond testicular torsion and common epididymo-orchitis.