Testicular Pain and Appendicitis
by Graham D. Keats M.D.
On the rare occasion, testicular pain can be secondary to the removal of a ruptured appendix. You are probably wonderig how in the world could the two be connected?
It all starts with a natural opening called the “patent processus vaginalis or PPV” that exists between the peritoneum (lining of the abdominal cavity) and the scrotum. It is present in 80-95% of male newborns but this percentage decreases to 37% by adulthood. The problem with a persistent PPV is that it allows intraperitoneal fluid to pass between the abdomen and the scrotum. So bacteria such as E. coli that should be contained only in the bowel are allowed to spread into areas like the scrotum where they set up a severe infection.
PPVs that persist into adulthood, also set a male up for an inguinal hernia of hydrocoele sometime within his lifetime.
Cases, thankfully rare, have been reported where a ruptured appendix has led to an acute scrotum for the very reason described above.
Sometimes during an appendectomy, the surgeon will discover and inguinal hernia or PPV. If such is the case, neither the hernia nor the PPV will be repaired at the time of the appendectomy. The reason being that a repair could isolate infected fluid within the scrotum, thereby setting the patient up for an abscessed scrotum.
Where a PPV is found to exist, post-op monitoring for scrotal abscess is imperative and early diagnosis is essential to prevent testicular gangrene. Should this occur, surgical intervention is necessary.
The patient routinely is given antibiotics following an appendectomy but monitoring is still essential should the testicle become infected with an organism not sensitive to the antibiotic administered.
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