Meconium periorchitis presenting as a para-testicular mass outside of the tunica vaginalis: case report

Meconium periorchitis is an uncommon but well-documented phenomenon by which intra-abdominal meconium reaches the scrotum via a patent processus vaginalis. This classically presents in a child first as a soft hydrocele, and later as a firm scrotal mass once calcification of the meconium occurs. We report a case of a 6-month-old boy with exam findings suspicious for perinatal testicular torsion who was taken for surgical exploration and found to have a meconium fecalith located inferior to the testicle and outside of the tunica vaginalis within the gubernaculum. The fecalith was excised and orchidopexy was performed. Meconium periorchitis needs to be considered in the differential diagnosis of pediatric scrotal masses. Overlooking this often-benign condition may lead to unnecessary surgery, potentially resulting in compromise of the testicle due to deliberate removal or unintended iatrogenic injury.