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Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis.

Nikiforov I, Mansoora Q, Al-Khalisy H, Joseph S, Cheriyath P - Case Rep Gastrointest Med (2015)

Bottom Line: Good blood flow was observed for both testicles.Conclusion.It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

View Article: PubMed Central - PubMed

Affiliation: Pinnacle Health Systems, 111 South Front Street, Harrisburg, PA 17101, USA.

ABSTRACT
Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT) scan of the abdomen showed acute pancreatitis. The patient's condition deteriorated and he was admitted to the intensive care unit (ICU). After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US) of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

No MeSH data available.


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Mentions: A 59-year-old male with a history of recently diagnosed hypertension presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest associated with nausea and nonbloody vomiting. He was started on hydrochlorothiazide (HCTZ) by his primary care physician ten days previously. The patient denied fever, chills, diarrhea, and dysuria. Past medical history was significant for occasional alcohol use. On physical examination, the patient showed abdominal tenderness in the upper quadrants and hypoactive bowel sounds. Vital signs were temperature 36°C, blood pressure 130/80 mm Hg, heart rate 127 beats per minute (bpm), respiratory rate 18 breaths per minute, and oxygen saturation of 99%. White blood cell (WBC) count was elevated at 16.1 × 103 cells/μL with 80 percent neutrophils, lipase 6312 U/L, glucose 178 mg/dL, alkaline phosphatase 69 U/L, alkaline transaminase 84 U/L, albumin 4.5 gm/dL, blood urea nitrogen 18 gm/dL, creatinine 1.32 mg/dL, and hemoglobin 16.1 g/dL. The patient underwent a computed tomography (CT) scan which showed peripancreatic edema and mild pancreatic fluid which was consistent with pancreatitis. The patient was put on a clear diet with aggressive intravenous (IV) fluid hydration. Blood cultures were negative. It was determined that his condition was most likely induced by HCTZ, and the medication was discontinued. His mental status deteriorated and he was transferred to the intensive care unit (ICU). A repeat abdominal CT scan done on the third day of his hospital stay showed increased ascites and peripancreatic edema with necrosis of the pancreatic head. The patient was placed on IV vancomycin and meropenem. The WBC increased to 25.7 × 103 cells/μL. By the sixth day, the patient's condition improved. A third CT scan of the abdomen was done on the eighth day of the hospital stay and showed a decrease in peripancreatic ascites from the previous CT scan and the appearance of peripancreatic fat stranding. On the ninth day of his hospital stay, the patient developed swelling of the scrotum and penis. An ultrasound done the next day showed that both testes were within normal limits and there was a large hydrocele bilaterally (Figure 1). There were no varicoceles or testicular masses. Good blood flow was observed for both testicles. Oral Lasix 40 milligrams twice daily was added to the medications to manage the swelling. Urinalysis was unremarkable. Echocardiogram showed normal ejection fraction with no signs of congestive heart failure. Over the next eight days, the hydrocele and swelling gradually diminished. On the eighteenth day, the patient was discharged home in stable condition.


Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis.

Nikiforov I, Mansoora Q, Al-Khalisy H, Joseph S, Cheriyath P - Case Rep Gastrointest Med (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495177&req=5

Mentions: A 59-year-old male with a history of recently diagnosed hypertension presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest associated with nausea and nonbloody vomiting. He was started on hydrochlorothiazide (HCTZ) by his primary care physician ten days previously. The patient denied fever, chills, diarrhea, and dysuria. Past medical history was significant for occasional alcohol use. On physical examination, the patient showed abdominal tenderness in the upper quadrants and hypoactive bowel sounds. Vital signs were temperature 36°C, blood pressure 130/80 mm Hg, heart rate 127 beats per minute (bpm), respiratory rate 18 breaths per minute, and oxygen saturation of 99%. White blood cell (WBC) count was elevated at 16.1 × 103 cells/μL with 80 percent neutrophils, lipase 6312 U/L, glucose 178 mg/dL, alkaline phosphatase 69 U/L, alkaline transaminase 84 U/L, albumin 4.5 gm/dL, blood urea nitrogen 18 gm/dL, creatinine 1.32 mg/dL, and hemoglobin 16.1 g/dL. The patient underwent a computed tomography (CT) scan which showed peripancreatic edema and mild pancreatic fluid which was consistent with pancreatitis. The patient was put on a clear diet with aggressive intravenous (IV) fluid hydration. Blood cultures were negative. It was determined that his condition was most likely induced by HCTZ, and the medication was discontinued. His mental status deteriorated and he was transferred to the intensive care unit (ICU). A repeat abdominal CT scan done on the third day of his hospital stay showed increased ascites and peripancreatic edema with necrosis of the pancreatic head. The patient was placed on IV vancomycin and meropenem. The WBC increased to 25.7 × 103 cells/μL. By the sixth day, the patient's condition improved. A third CT scan of the abdomen was done on the eighth day of the hospital stay and showed a decrease in peripancreatic ascites from the previous CT scan and the appearance of peripancreatic fat stranding. On the ninth day of his hospital stay, the patient developed swelling of the scrotum and penis. An ultrasound done the next day showed that both testes were within normal limits and there was a large hydrocele bilaterally (Figure 1). There were no varicoceles or testicular masses. Good blood flow was observed for both testicles. Oral Lasix 40 milligrams twice daily was added to the medications to manage the swelling. Urinalysis was unremarkable. Echocardiogram showed normal ejection fraction with no signs of congestive heart failure. Over the next eight days, the hydrocele and swelling gradually diminished. On the eighteenth day, the patient was discharged home in stable condition.

Bottom Line: Good blood flow was observed for both testicles.Conclusion.It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

View Article: PubMed Central - PubMed

Affiliation: Pinnacle Health Systems, 111 South Front Street, Harrisburg, PA 17101, USA.

ABSTRACT
Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT) scan of the abdomen showed acute pancreatitis. The patient's condition deteriorated and he was admitted to the intensive care unit (ICU). After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US) of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

No MeSH data available.


Related in: MedlinePlus