Scrotum

Abstract

The scrotum consists of skin, the dartos muscle, and external spermatic, cremasteric, and internal spermatic fasciae. Embryologically, it originates from the genital swellings that meet ventrally to the anus and unite to form the two scrotal sacs. A median raphe of fibrovascular connective tissue separates the two halves.

Littre's hernia is defined as any hernial sac, which contains a Meckel’s diverticulum. It has been reported in association with inguinal, umbilical, femoral, sciatic, ventral, and lumbar hernias. Littre reported this variant of inguinal hernia for the first time in 1700. Amyand’s hernia is acute appendicitis or its complications in an inguinal hernia; it is rare and generates case reports; only 0.13% of cases of acute appendicitis occurred in external hernia.

Hydrocele of the canal of Nuck is an important differential diagnosis for an irreducible hernia in female patients. Clinically, this hydrocele may mimic both inguinal and femoral hernia and even present as strangulation. An associated inguinal hernia reported in one third of cases could also be mistaken for Bartholin’s cyst of labium majus, which is relatively more common. Abdominoscrotal hydrocele is a rather rare condition, which is difficult to differentiate from an inguinal hernia. In this condition, part of the sac is in the scrotum, and part is in the abdomen. Ectopic scrotum is an anomalous position of one hemiscrotum along the inguinal canal; it is a rare condition and could be considered as an extreme spectrum of penoscrotal transposition.

Most commonly, ectopic scrotum is suprainguinal although it may also be infrainguinal or perineal. Accessory scrotum is considered the rarest of all congenital scrotal abnormalities. It has been observed in isolation or in conjunction with other anorectal/urogenital abnormalities such as hypospadias, perineal lipoma, and perineal lipoblastoma. Bifid scrotum refers to the deformity in which the labioscrotal folds are completely or partially separated and without a median raphe. This anomaly is most often associated with proximal hypospadias.

Scrotal hypoplasia is the underdevelopment of one or both sides of the scrotum. This anomaly occurs mostly in boys with an undescended testis and frequently noted in infants with genital ambiguity due to deficient testosterone secretion. Scrotal agenesis is an extremely rare congenital anomaly, and few cases had been reported characterized by complete absence of development of scrotum. Scrotoschisis is a testicular extrusion through the scrotal wall; it is a congenital defect in the integrity of the scrotal wall permitting egress of the testis to an ectopic extracorporeal location. Scrotolithiasis and scrotal calicinosis is benign incidental extra- or intratesticular macrocalcifications within the scrotum that frequently occupy the potential space of the tunica vaginalis or sinus of the epididymis and are usually of no clinical significance; they could be of varying sizes.