From the Guidelines
Ascending leg cellulitis can lead to scrotal swelling due to the spread of infection through connected tissue planes and lymphatic channels, and prompt recognition and treatment are crucial to prevent severe complications like Fournier’s gangrene. This occurs because the infection and inflammation in the leg can spread upward, eventually affecting the genital area, with scrotal swelling often due to lymphatic obstruction and edema rather than direct infection of the scrotal tissues 1. According to the European Association of Urology guidelines, Fournier’s gangrene is an aggressive and frequently fatal polymicrobial soft-tissue infection of the perineum, perianal region, and external genitalia, with patient risk factors including immunocompromised status, recent urethral or perineal surgery, and high body mass index 1.
The diagnosis of Fournier’s gangrene is mainly clinical, and a focused and detailed medical history as well as a complete physical examination, including a careful inspection of the perineum, is mandatory 1. The most common symptoms of Fournier’s gangrene include perineal and/or scrotal pain, swelling, and erythema, with systemic features such as fever and tachycardia often present 1.
Treatment typically involves broad-spectrum antibiotics, with subsequent refinement according to culture results and clinical response, and adequate repeated surgical debridement with urinary diversion via a suprapubic catheter is necessary to reduce mortality 1. The use of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score and Fournier’s Gangrene Severity Index (FGSI) score can help in guiding correct management, with early diagnosis and stratification of patients into risk categories being crucial for optimal outcomes 1. Patients should seek immediate medical attention if scrotal swelling develops during the course of cellulitis, as this may indicate progression of infection requiring more aggressive management.
Key points to consider in the management of ascending leg cellulitis and potential scrotal swelling include:
- Prompt recognition and treatment of the infection to prevent severe complications like Fournier’s gangrene
- Use of broad-spectrum antibiotics and subsequent refinement according to culture results and clinical response
- Adequate repeated surgical debridement with urinary diversion via a suprapubic catheter to reduce mortality
- Early diagnosis and stratification of patients into risk categories using LRINEC score and FGSI score
- Monitoring for systemic symptoms like fever and tachycardia, and seeking immediate medical attention if scrotal swelling develops during the course of cellulitis.
From the Research
Ascending Leg Cellulitis and Scrotal Swelling
- Ascending leg cellulitis is a common emergency that can have substantial short-term and long-term morbidity 2
- While the provided studies do not directly address the question of whether ascending leg cellulitis can lead to scrotal swelling, they do discuss the potential for cellulitis to spread and cause more severe infections
- Fournier's gangrene, a rare and life-threatening condition, can present with scrotal swelling and is often preceded by cellulitis or other infections in the genital or perineal area 3, 4, 5
- The symptoms of Fournier's gangrene can be non-specific and may include scrotal pain, fever, abscesses, crepitus, erythema, and cellulitis 5
- It is possible that ascending leg cellulitis could spread to the scrotal area and cause swelling, especially if left untreated or if the patient has underlying risk factors such as diabetes or immune compromise 6
- However, the provided studies do not provide direct evidence to support this specific scenario, and further research would be needed to fully understand the relationship between ascending leg cellulitis and scrotal swelling
Risk Factors and Treatment
- Risk factors for developing cellulitis and other infections include prior episodes of cellulitis, cutaneous lesions, tinea pedis, and chronic edema 2, 6
- Treatment for cellulitis typically involves oral antibiotics, and recurrent episodes may require antimicrobial prophylaxis 6
- Fournier's gangrene requires prompt diagnosis and treatment with surgical debridement, broad-spectrum antibiotics, and intravenous fluids 3, 4, 5