(CR41) "The Pain is Not There!" An Unusual Presentation of a Case of Prepubertal Epididymo-Orchitis

Introduction:

Epididymo-orchitis is rare in the prepubertal period. It is common in toddlers or adults who present with scrotal pain, swelling, lower urinary tract infection and fever. Epididymo-orchitis, strangulated hernia and testicular torsion may share similar features on ultrasound imaging. It affects the management of patients, either surgery or antibiotic treatment. We present a case of prepubertal epididymo-orchitis who presented with abdominal pain.  

Case Report/Description :

A 10-year-old boy presented with right iliac fossa pain, vomiting and no bowel opening for 1 day. No fever. No abdominal distension. Abdominal radiograph showed fecal loaded bowels. Normal total white cell count. Normal abdomen and pelvis ultrasound examination. Clinically there was right inguinal swelling. Right inguinal canal ultrasound showed a non-vascular soft tissue lesion, suspicious of a herniated bowel loop or thickened spermatic cord. The right testis was echogenic and swollen, no doppler signal demonstrated. Right inguinal exploration showed undescended right testis with epididymo-orchitis. The avascular soft tissue lesion thought to be the herniated bowel loop was actually the thickened epididymis and spermatic cord. Child discharged 2 days after orchidopexy. 

Discussion/Conclusion :

Epididymo-orchitis may occur in children who present with non-specific abdominal pain. The thickened epididymis and spermatic cord in our case was at high position in the inguinal canal due to undescended testis, mimicking strangulated bowel loop. We hope to bring insight for both clinicians and radiologists in the approach of acute pediatric abdominal pain. This case stressed the importance of inguinal examination in symptomatic children when the ultrasound abdomen and pelvis revealed no significant finding.