Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child

The acute scrotum had resulted from spreading perianal infection due to erosion of the circlage wire. The condition was treated with antibiotics and removal of the wire. The child made an uneventful recovery.This case highlights that patients with Thiersch wire should be followed until the wire is removed. Awareness of anal lesions as a cause of acute scrotal conditions, and history and physical examination are emphasized.Acute scrotum is a surgical emergency. Causes are usually intra scrotal conditions, of which torsion of the testis is the most important. Less common causes are extra scrotal in origin, namely idiopathic scrotal edema. Anal conditions are rare causes of acute scrotum. Diagnosis sometimes may be very difficult without surgical exploration. Careful history taking and physical examination including perianal region is emphasized.B.S. a 4-year-old male child was admitted to the pediatric surgical ward at Jordan University Hospital because of two days history of swelling, redness and pain of his scrotum (Fig. 1). There was no history of trauma. The pain was moderate, not characteristic of torsion, and not the chief complaint. Oral temperature was 37.8°C and pulse 94/min. Physical examination revealed bilateral red swollen scrotum, moderately hot and tender allowing examination of the testes, which were in normal position and of equal size and not tender. There was a small amount of fluid bilaterally detected on transillumination. The rest of the physical examination was unremarkable. Laboratory work up showed Hb. 10.5 gm/dl, Hct. 32%, WBC 12.7 × 103/mm3 and normal serum amylase. Ultrasound examination confirmed the equal sized testes, with normal echogenicity, the presence of small amount of fluid in the scrotum, and the edematous scrotum. On further examination of the scrotum, a streak of redness extended along the midline raphe to the perineum, where a visible wire through an eroded perianal skin was seen (Fig 2). The patient underwent a Thiersch wire