Solution: "What's Your Diagnosis?"
Answer #1: (1) CBC and chemistry profile, and (2) Abdominal/scrotal ultrasound
Diagnostic results:
(1) CBC and chemistry is unremarkable aside from an increased ALT, GGT, and cholesterol.
(2) Ultrasound images: The scrotum is severely edematous. There is free fluid within it. The spermatic cords and testicles are thickened and severely mottled. There is no normal architecture present. Assessment: Completely distorted intrascrotal architecture with fluid and edema. Rule out necrosis secondary to torsion or other cause.
Question #2: What is your treatment plan?
Answer #2: Castration and scrotal ablation with culture of fluid +/- histopathology.
Based on clinical presentation, physical exam, and history, it was believed that Milo had a testicular torsion. Clinical signs usually include severe abdominal pain, testicular and scrotal swelling, and sometimes vomiting. The spermatic cord is usually thickened. Torsions occur more frequently with intra-abdominal testes than scrotal testes. Ischemia usually occurs within 1-2 hours which permanently damages spermatogenesis. The treatment for testicular torsion is castration.
During the castration/scrotal ablation, it was discovered that there was not a testicular torsion, but there was a scrotal abscess. Culture came back as Beta hemolytic streptococcus and Serratia marcescnes. These were both susceptible to Baytril, which was the antibiotic Milo was prescribed. Milo was also sent home with a few days of Tramadol and Rimadyl.
Aerobic bacteria such as Brucella canis, Mycoplasma, Ehrlichia, and Blatomyces are often the cause of orchitis. The most common routes of retrograde infection are the prostate, urethra, and the urinary bladder. Penetrating wounds can also lead to infection. It is common for abscesses to form. Inflammation, hyperthermia, and bacteria can permanently damage spermatogenesis. The appropriate antimicrobial treatment should be started based on culture results. If the infection becomes systemic, lethargy and fever are often noted. Whether or not surgery is performed, antibiotics should still be given.