What Is Causing Scrotal Swelling, Pain, and Discoloration After a Man’s Vasectomy?

Authors:
Jamshid S. Mian, MD
Mian Family Medicine, Rosedale, Maryland

Chris Boseovski, DMD, MS-III, and Chase Henderson, MCS, MS-III
Trinity Medical Sciences University, Saint Vincent and the Grenadines

Citation:
Mian JS, Boseovski C, Henderson C. What is causing scrotal swelling, pain, and discoloration after a man’s vasectomy? Consultant. 2019;59(3):81-83.

A 29-year-old man presented to his primary care provider with a severely swollen purple and blue scrotum and bilateral ecchymosis along the lateral thigh and suprapubic area (Figures). He had undergone an outpatient no-scalpel vasectomy (NSV) the day before.

The patient’s medical history was positive for irritable bowel syndrome (IBS), hemorrhoids, and gastroesophageal reflux disease. His surgical history included a right arthroscopic shoulder repair. At presentation, he reported a dramatic increase in scrotal swelling over the past 24 hours, with extension to the perineum, accompanied by significant pain on defecation. The patient stated that he initially had attempted to return to the urologist but had been unable to get an appointment at that time; he had been advised by his surgeon to apply ice to the area and to elevate the scrotum.

After consultation with his primary care provider, the patient was advised to go to the emergency department, where he was subsequently admitted to the hospital.

What is the cause of this man’s pain and scrotal swelling?

A. Testicular torsion
B. Strangulated inguinal hernia
C. Fournier gangrene
D. Scrotal hematoma