Pancreatitis gone nuts: Scrotal hydrocele as a complication
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A 33-year-old male with acute gallstone pancreatitis complicated by pancreatic fluid collection formation developed intense right-sided scrotal pain and swelling one week into his hospitalization. Computed tomography revealed inflammatory stranding near the pancreatic head with adjacent compression onto the stomach and duodenum and new marked edema of the right inguinal canal and hemiscrotum with inflammatory peripancreatic fluid visibly tracking down into the pelvis. Immediate scrotal exploration by the urology service yielded several hundred milliliters of cloudy, lipase-rich fluid from the right hydrocele sac, confirming the inguinoscrotal inflammatory fluid to be of pancreatic origin. The right testicle appeared viable and preserved without signs of infection or necrosis and local percutaneous drainage was achieved intra-operatively via placement of two small caliber drains into the right scrotum to ensure complete resolution. The drains were removed seven days after insertion when output ceased. The patient eventually required endoscopic transluminal drainage of the evolving pancreatic head fluid collection for persistent anorexia and abdominal pain...

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