Asian Journal of Case Reports in Surgery

Inguinoscrotal Manifestations of Antenatal Bowel Perforation

A. Amous

Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, BN1 3JN and King Faisal Specialist Hospital and Research Center, Medinah, 42523, Saudi Arabia.

R. Fettiplace

Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, BN1 3JN and King Faisal Specialist Hospital and Research Center, Medinah, 42523, Saudi Arabia.

A. A. Mahomed *

Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, BN1 3JN and King Faisal Specialist Hospital and Research Center, Medinah, 42523, Saudi Arabia.

*Author to whom correspondence should be addressed.

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Abstract

Aim: Antenatal gastrointestinal perforation is a well recognised entity and is evident at birth with gastrointestinal obstruction by volvulus, atresia, intussusception, stenosis or inspissated meconium in 50% of cases. Exclusive inguinoscrotal presentation of this condition is rare and its different manifestations are highlighted.

Methods: A retrospective report of two infants with inguinoscrotal manifestations of antenatal gastrointestinal perforation. The first, a 2 months old with a tense unilateral inguinoscrotal hydrocoele and the second, a 2 days old premature child with a suspected incarcerated hernia, were investigated by plain abdominal X ray and ultrasound scan prior to surgical exploration. The excised hydrocoele sacs were submitted to histology.

Results: Abdominal X ray and ultrasound scan revealed dense scrotal and scattered intra-abdominal calcification in the first case. No calcification was detectable in the latter case in which histology confirmed meconium laden macrophages in the wall of the encysted hydrocoele. Surgery was curative in both. In the absence of a family history, screening for cystic fibrosis mutation was negative for both.

Conclusion: Antenatal gastrointestinal perforation may present in atypical fashion with principally inguinoscrotal signs. A high level of suspicion is necessary when calcification is noted in both the scrotum and abdomen although its absence in both sites does not exclude previous bowel perforation. Surgical management of the inguinoscrotal problems are sometimes necessary and histology of tissue may provide the only clue as to the diagnosis. In either event exclusion of cystic fibrosis is mandatory.

Keywords: Antenatal gastrointestinal perforation, hydrocoele sacs, abdominal x-ray, inguinoscrotal signs

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