A 5-day-old term male neonate presented with scrotal
swelling, which was brilliantly transilluminant (even without the use of
torch), with shiny overying skin (Fig.1) and gross
abdominal distension (inset image). It was soft to touch, easily
reducible with characteristic refilling with air. This differentiated it
from hydrocele of tunica vaginalis and lymphangioma of inguinoscrotal
region. There was history of rectal instrumentation for delayed passage
of meconium, following which the symptoms gradually developed. As
clinical signs of perforation peritonitis with pneumoscrotum were
evident, an exploratory laparotomy was performed, which revealed a rent
in the recto-sigmoid. The scrotal swelling spontaneously reduced as the
peritoneal cavity was opened, which again differentiated it from
hydrocele. Repair of perforation was done after taking biopsy from
margins. Histopathological examination of the specimen ruled out
Hirschsprungs disease. Patient had unevenful recovery and was discharged
on 9th day.
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Fig.1 Brilliantly transilluminant
scrotum suggestive of pneumoscrotum.
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Pneumoscrotum secondary to recto-sigmoid perforation
following rectal instrumentation is extremely rare. Management must be
directed towards its cause. Rectal irrigation must be performed gently
with small volume (5-10 mL) of normal saline, using soft red rubber
catheter to prevent such complications.