Recurrent Scrotal Abscess with Post-Drainage Complications

Case at a Glance

A 38-year-old obese male with a history of tobacco use presented with recurrent scrotal abscess that spontaneously ruptured, followed by progressive scrotal swelling and discomfort.

Patient's Story

The patient, a 38-year-old male (height 6'1", weight 300 lbs) with a significant smoking history, developed his second episode of a scrotal abscess located on the right side beneath the scrotum. Seven days after initial symptom onset, he presented to the emergency department due to unbearable pain. During his walk into the hospital, the abscess spontaneously ruptured with profuse purulent drainage soaking through his clothing. Two days post-rupture, he noticed progressive swelling of the entire scrotum accompanied by mild discomfort and pruritus at the drainage site. The swelling appeared to worsen when sitting upright.

Initial Assessment

Obese male with risk factors including tobacco use presenting with recurrent scrotal abscess. Current medications include diphenhydramine, ibuprofen, acetaminophen, and two concurrent antibiotic regimens. Patient reported minimal pain following spontaneous drainage but expressed concern about progressive scrotal edema.

The Diagnostic Journey

The patient's presentation suggested possible complications following abscess drainage, including potential hydrocele formation, residual infection, or lymphatic obstruction. Differential diagnosis included post-infectious hydrocele, scrotal cellulitis, or incomplete abscess drainage with fluid collection.

Final Diagnosis

Post-infectious scrotal swelling with suspected hydrocele formation following spontaneous drainage of recurrent scrotal abscess

Treatment Plan

Continue current antibiotic therapy, monitor for signs of residual infection or abscess reformation. Clinical evaluation for areas of fluctuance to determine need for surgical drainage. Consider scrotal ultrasound to differentiate between hydrocele and other fluid collections.

Outcome and Follow-up

Patient advised to return for urgent evaluation if pain increases, fever develops, or areas of fluctuance are noted. Surgical consultation recommended if conservative management fails or if imaging reveals significant fluid collections requiring drainage.