Pediatric Intratesticular Abscess Managed with a Testicular-Sparing Approach: A Case Report

Abstract
Intratesticular abscess is an uncommon condition in children, often arising as a complication of epididymo-orchitis or hematogenous spread of infection. Testicular loss is a feared outcome, as timely diagnosis is often delayed due to nonspecific presentation. We report a rare case of pediatric intratesticular abscess successfully managed with a testicular-sparing approach, highlighting the importance of early imaging, surgical decision-making, and organ preservation.

Introduction

Intratesticular abscesses are rare in the pediatric population, with most reported cases occurring in adults. The condition usually follows severe epididymo-orchitis, trauma, or bacteremia. Given the potential for compromised testicular viability, orchiectomy has traditionally been the standard surgical option. However, with advances in imaging and surgical techniques, testicular-sparing approaches have gained prominence in selected cases. Here, we present a child with an intratesticular abscess managed successfully by a conservative surgical approach.

Case Presentation

A 7-year-old boy presented with a 5-day history of scrotal pain, swelling, and fever. There was no history of trauma, urinary tract infection, or prior urogenital surgery. On examination, the right hemiscrotum was swollen, tender, and erythematous. The left testis was normal.

• Laboratory findings: Elevated white blood cell count (14,500/µL) with neutrophilia; C-reactive protein was raised. Urine analysis was normal.
• Ultrasonography with Doppler: Revealed a well-defined hypoechoic intratesticular lesion with peripheral vascularity measuring 2.5 × 2.0 cm in the right testis, consistent with abscess. Surrounding testicular parenchyma showed preserved vascularity.

Management:
After discussion with the parents, a decision was made to attempt testicular preservation. Under general anesthesia, a scrotal exploration was performed. The abscess cavity was localized and drained, with thorough irrigation. Healthy testicular parenchyma was preserved. Pus culture grew Staphylococcus aureus, sensitive to ceftriaxone. Postoperative antibiotics were given for 10 days.

Outcome:
The patient made an uneventful recovery. At 3-month follow-up, ultrasonography revealed a preserved right testis with normal echotexture and vascularity. The patient remained asymptomatic.

Discussion

Intratesticular abscesses in children are exceedingly rare, with few cases documented in the literature. The pathogenesis is often linked to bacterial orchitis or systemic infection. Clinical differentiation from testicular torsion or tumor can be challenging, making ultrasonography indispensable.

Traditionally, orchiectomy was the treatment of choice due to concerns regarding residual infection or recurrence. However, with early diagnosis and improved perioperative care, testicular-sparing approaches such as abscess drainage and parenchymal preservation can achieve favorable outcomes, especially when viable tissue and vascularity are preserved.

In our case, ultrasonography helped confirm preserved vascularity, justifying a conservative approach. Early intervention led to excellent recovery and long-term preservation of testicular function.

Conclusion

Pediatric intratesticular abscess is a rare but treatable condition. Ultrasonography plays a crucial role in diagnosis and surgical planning. A testicular-sparing approach should be considered in children when testicular viability is intact, to preserve organ function and avoid unnecessary orchiectomy.