- 期刊
Epididymo-Orchitis in an Infant Resulting from Escherichia Coli Urinary Tract Infection
嬰兒大腸桿菌性泌尿道感染導致急性副睪睪丸炎：一病例報告
摘要
副睪睪丸炎(epididymo-orchitis)在嬰兒時期是種罕見的疾病，由於臨床症狀表現和睪丸扭轉(torsion of testis)很相似，故時常是在實施陰囊探查手術後才被診斷。該疾病發病的病理機轉並不很清楚，雖然有些病例報告了相關的致病源，但大多數的副睪睪丸炎仍查不出病因。此篇報告一例三個月大的小男嬰入院前24小時開始顯得有些激躁，稍後由母親於洗澡時發現左側陰囊逐漸紅熱腫大，左側睪丸質塊也變大，此外，無其它不適，經地方診所臆斷爲睪丸扭轉而轉送本院治療。經理學、陰囊部核子醫學鎝(Tc-99m)放射性核種閃爍造影、實驗室和腹部、腹股溝陰囊部診斷超音波等檢查後，將睪丸扭轉和箝閉性疝氣之外科急症予以排除，而在副睪睪丸炎的診斷下接受內科療法。在完成尿液、血液之常規和培養檢查後，即以靜脈注射抗生素(oxacillin 100mg/kg/day和amikacin 15 mg/kg/day)治療，第二天因病況無改善而將oxacillin改爲ampicillin(100 mg/kg/day)，第四天血液培養初步報告無微生物生長，而尿液中則長出大腸桿菌(Escherichia coli)，最後在大腸桿菌性泌尿道感染導致急性副睪睪丸炎的診斷下，繼續接受靜脈注射第三性抗生素(cefazoline 100 mg/kg/day和Amikacin 15 mg/kg/day)治療滿10天，病灶改善。此外，該病嬰在上述檢查中同時發現患有兩側腹股溝疝氣和陰囊水腫，於住院第11天接受疝氣修補手術後，第16天健癒出院，出院後門診追蹤複查皆爲正常。
並列摘要
Epididymo-orchitis(EO) is said to be extremely rare in infants and children. It is usually diagnosed after scrotal exploration for symptoms which mimic manifestations between EO and torsion of the cord and its appendage. The pathophysiologic mechanisms for the development of EO are not well known. Although some causative agents of EO have been reported, in most cases there was no clear etiology. We report a 3-month-old male infant who had been well until the day prior to admission when irritability, left testicular swelling, scrotal erythema with a hot sensation were noted by his mother. He was treated medically after excluding the possibility of an emergent surgical condition(such as torsion of the cord and its appendage, or incarcerated hernia) by means of physical examinations, abdominal and inguino-scrotal sonography, laboratory studies, and testicular radionuclide scintigraphy. A catheterized sample of urine for culture yielded Escherichia coli. There was the possibility that the EO was caused by hematogenous rather than local spread form an infection of the urinary tract. He was treated with a 10-day course of intravenous cefazolin and amikacin. Following this, he inproved clinically and a repeat catheterized urine sample remained sterile on culture. In addition, a bilateral inguinal hernia and hydrocele were detected by inguino-scrotal sonography and were operated on the 11th hospital day. He was discharged on the 16th day of hospitalization and remained well 11 months after discharge.