![]() ![]() The ischemic effect is made by indirect action of cocaine by blocking the reuptake of neurotransmitters, which leads to the local vasoconstriction. ![]() In 1999, Li and colleagues reported the effects of cocaine on testicular circulation in rats ( 3, 4). The action of cocaine in testicular circulation is very little reported in the literature. Coincidentally, he said that the pain worsened than ever after cocaine abuse. Testicular pain became more intense when he began to abuse cocaine three hours before seeking medical help. Thus, the patient was immediately taken to the surgical scrotal exploration ( Figure 1 and and2 2).įrom the intraoperative clinical findings it was necessary to return to clinical history to discover the true etiology of the present Acute Scrotum Syndrome.ĭuring the examination of the patient in the emergency room the patient had altered vital signs such as tachycardia, tachypnea and psychomotor agitation, which improved after the use of sedatives in pre-and intraoperative periods. The sonographic/doppler diagnosis was reduced blood flow to the remaining testicle, strongly suggesting the diagnosis of torsion of the spermatic cord or testis. Knowing that the current acute symptom might have the same etiology, we were asked for scrotal ultrasound-doppler, which was made in less than 20 minutes. The patient had a similar episode of acute scrotum 13 years ago due to a spermatic cord torsion, which resulted in right orchiectomy when he was only 13 years old. This is a 27 year-old man diagnosed with Acute Scrotum syndrome with typical characteristics presented by the acute onset of the history of scrotal pain. Testicular Torsion is a condition which must always be considered in cases of acute scrotum syndrome and orchiectomy may be the final result of diagnosis and treatment delay. In addition, depending on the underlying disease that causes Acute Scrotum Syndrome, time is a critical factor for treatment success. The most common differential diagnoses are twisting of the spermatic cord, testicular or appendix torsion, epididymitis, orchitis, inguinal hernia, local trauma, sexual abuse, testicular tumor, scrotal idiopathic edema, cellulitis, vasculitis among others and the ultrasound-Doppler examination is important tool for elucidate the etiologic diagnosis ( 2).Ī careful history and physical examination are of vital importance for the correct diagnosis. The spectrum of conditions affecting the scrotum and its content ranges from incidental findings to acute pathologic events that require diagnosis and emergency treatment. However, some cases are described in newborns ( 1). ![]() The typical presentation is known as Acute Scrotum Syndrome and usually presents in adolescents and young adults. The sudden onset of clinical symptoms, within a short period of time, scrotal pain or the elements of its contents, with or without increase in scrotal volume is an urologic emergency. Physicians should consider in the differential diagnosis, since the use of illicit drugs, such as cocaine, is quite prevalent among adolescents and young adults around the world.ĭiscussion and future perspectives: what it might add and how does it relate to the current literature It is important to be reported because it can become a differential diagnosis of acute scrotum syndrome. In fact, it is related to vasoconstriction by chronic cocaine use, worsened with the intensive and acute drug use in the last three days. Furthermore, its main etiology is cocaine abuse, which presents with clinical features that mimic the twist testis or spermatic cord. Why is it important and is being Reported?Īfter an extensive review of literature and as far as we know, this is the first published case report in the literature related to Acute Scrotum Syndrome caused by ischemia. Precepts, clinical and basic reasoning supporting the case (s) and the hypothesis raised scenario. ![]()
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