Idiopathic Epididymo-Orchitis and Pyocele in a Preterm Newborn: A Case Report

Epididymo-orchitis (EO) is an extremely rare condition in preterm infants and usually results from hematogenous bacterial spread or urinary infections linked to structural abnormalities. We describe a preterm newborn, born at 36 weeks of gestation, with a left-sided diaphragmatic hernia. After successful surgery at 12 h of life, the newborn developed red and tender swelling of the right scrotum on the 13th postoperative day. Color Doppler ultrasonography revealed an abrupt cessation of vascular flow at the base of the right scrotum and peri-testicular fluid. Urinalysis results were unremarkable. Surgical exploration revealed pus in the tunica vaginalis and congestion of the right epididymis and testis, confirming the diagnosis of EO and pyocele. The peri-testicular space was cleaned and drained. Blood and peri-testicular pus cultures revealed the growth of Escherichia coli, while urine culture showed no growth. After 3 days of scrotal drainage and a 10-day antibiotic course, the infant improved. Follow-up ultrasound on Day 14 after surgery showed normal testicular size and structure. EO and pyocele should be considered in acute scrotal swelling in a preterm. The absence of sepsis, urinary tract infection, or urinary tract abnormalities does not preclude the diagnosis.