Scrotal Abscess Induced by Spontaneous Bacterial Peritonitis Involving Enterococcus cecorum

A 60-year-old man with idiopathic portal hypertension and ascites presented with fever, abdominal pain, and right scrotal swelling. He was diagnosed with spontaneous bacterial peritonitis (SBP) and a communicating right hydrocele, and antibiotic treatment was initiated. Despite treatment, his fever and elevated inflammatory markers persisted, accompanied by progressive genital pain. On day 21, he was diagnosed with a scrotal abscess. Owing to a poor response to antibiotics, and because scrotal ultrasound revealed a multiloculated abscess without any drainable cavity, an orchiectomy was performed on day 108. Enterococcus cecorum, identical to that identified in ascitic fluid, was isolated from the surgical specimen. Communicating hydroceles associated with ascites have been reported; however, no previous reports have described scrotal abscesses resulting from SBP. In this case, antibiotic treatment was ineffective, necessitating surgical excision. This case highlights the importance of careful monitoring of patients with SBP and hydrocele, as scrotal abscesses may develop.