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We hereby present a rare cause of acute scrotum secondary to emphysematous epididymo-orchitis (EEO). It is often not diagnosed until crepitus is palpable in the scrotal wall with spreading cellulitis, at which point it has reached an advanced stage. This case report details a 55-year-old man with poorly controlled diabetes who presented with an acute scrotum that failed to resolve with oral antibiotics in primary care. Following rapid detection of EEO on an early scrotal ultrasound scan, the patient had surgical debridement and a near-total orchidectomy with only a small stump of testis and tunica albuginea left behind. This case highlights the importance of timely imaging, particularly in diabetic men with an acute scrotum with a high clinical suspicion of intratesticular abscess. An incidental but significant finding of EEO would warrant early surgical intervention to prevent a catastrophic sequelae i.e. Fournier’s gangrene.

Emphysematous epididymo-orchitis: imaging plays a vital part in active management: case report and literature review