Accumulation of gas in the scrotum may arise from:
(1) local infection with gas producing organisms
(2) dissection of gas from other sites:
(2a) air from a pneumothorax
(2b) gas from an intestinal perforation following ulceration, anastomotic leak or other defect in the bowel wall, usually in the sigmoid colon or rectum
(2c) insufflation of the bowel with gas during colonoscopy
(2d) insufflation of the abdominal cavity (laparoscopy, other)
(2e) insufflation of the retroperitoneum
(2f) penetrating injury of the retroperitoneum, such as renal biopsy
Clinical findings:
(1) with local infection there are local and systemic signs of inflammation, typically with fever.
(2) scrotal swelling, which may be marked
(3) crepitus may or may not be present
Local infection with gas formation or perforation of the bowel are potentially life-threatening and require aggressive management. The other causes will usually resolve without specific therapy.
