Hidradenitis suppurativa (HS) – NHS

Hidradenitis suppurativa (HS) is a painful, long-term skin condition that causes skin abscesses and scarring on the skin.

The exact cause of hidradenitis suppurativa is unknown, but it occurs near hair follicles where there are sweat glands, usually around the groin, bottom, breasts and armpits.

For reasons that are unknown, more women than men have the condition. It’s thought to affect about 1 in 100 people.

Symptoms

The symptoms of hidradenitis suppurativa range from mild to severe.

It causes a mixture of boil-like lumps, blackheads, cysts, scarring and channels in the skin that leak pus.

Hidradenitis suppurativa can cause fleshy lumps to grow on the surface of the skin

Credit:

GIRAND/BSIP/SCIENCE PHOTO LIBRARY https://www. sciencephoto.com/media/668613/view

Sometimes, narrow channels (sinus tracts) form under the skin, which can break out on the surface and leak pus

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Alamy Stock Photo https://www.alamy.com/stock-photo-hidradenitis-suppurativa-52484079.html?pv=1&stamp=2&imageid=B6F62B10-1A6C-45D2-B395-4D3CF16D45CE&p=17774&n=0&orientation=0&pn=1&searchtype=0&IsFromSearch=1&srch=foo%3dbar%26st%3d0%26pn%3d1%26ps%3d100%26sortby%3d2%26resultview%3dsortbyPopular%26npgs%3d0%26qt%3dD1ARYB%26qt_raw%3dD1ARYB%26lic%3d3%26mr%3d0%26pr%3d0%26ot%3d0%26creative%3d%26ag%3d0%26hc%3d0%26pc%3d%26blackwhite%3d%26cutout%3d%26tbar%3d1%26et%3d0x000000000000000000000%26vp%3d0%26loc%3d0%26imgt%3d0%26dtfr%3d%26dtto%3d%26size%3d0xFF%26archive%3d1%26groupid%3d%26pseudoid%3d%7bA883FDE5-7F3D-4472-81F5-B61111916852%7d%26a%3d%26cdid%3d%26cdsrt%3d%26name%3d%26qn%3d%26apalib%3d%26apalic%3d%26lightbox%3d%26gname%3d%26gtype%3d%26xstx%3d0%26simid%3d%26saveQry%3d%26editorial%3d1%26nu%3d%26t%3d%26edoptin%3d%26customgeoip%3d%26cap%3d1%26cbstore%3d1%26vd%3d0%26lb%3d%26fi%3d2%26edrf%3d0%26ispremium%3d1%26flip%3d0%26pl%3d

The condition tends to start with blackheads, spots filled with pus and firm pea-sized lumps that develop in one place. The lumps will either disappear or rupture and leak pus after a few hours or days.

New lumps will then often develop in an area nearby. If these are not controlled with medicine, larger lumps may develop and spread. Narrow channels called sinus tracts also form under the skin that break out on the surface and leak pus.

Hidradenitis suppurativa can be very painful. The lumps develop on the skin in the following areas:

• around the groin and genitals
• in the armpits
• on the bottom and around the anus
• below the breasts

The lumps may also appear on the nape of the neck, waistband and inner thighs.

Some of the lumps may become infected with bacteria, causing a secondary infection that will need to be treated with antibiotics.

Many people with hidradenitis suppurativa also develop a pilonidal sinus, which is a small hole or “tunnel” in the skin at the top of the buttocks, where they divide (the cleft).

What causes hidradenitis suppurativa?

The exact cause of hidradenitis suppurativa is unknown, but the lumps develop as a result of blocked hair follicles.

Smoking and obesity are both strongly associated with hidradenitis suppurativa, and if you’re obese and/or smoke it will make your symptoms worse.

Hidradenitis suppurativa usually starts around puberty, but it can occur at any age after puberty. This may suggest that sex hormones play a part. Many people with the condition also have acne and excessive hair growth (hirsutism).

In rare cases, hidradenitis suppurativa may be linked to Crohn’s disease, particularly if it develops around the groin area and the skin near the anus. Crohn’s disease is a long-term condition that causes the lining of the digestive system to become inflamed.

Hidradenitis suppurativa runs in families in about 1 in 3 cases. It’s not infectious and isn’t linked to poor hygiene.

Diagnosing hidradenitis suppurativa

There’s no definitive test to help diagnose hidradenitis suppurativa.

A GP will examine the affected areas of skin, and they may take a swab of an infected area. This can be helpful in making a diagnosis because the condition is not usually associated with the presence of bacteria that cause skin infections.

Hidradenitis suppurativa could be mistaken for acne or ingrown hairs.

Treating hidradenitis suppurativa

Hidradenitis suppurativa is a lifelong, recurring condition that is often difficult to manage, although the symptoms may improve or eventually stop with treatment.

It’s important to recognise and diagnose the condition in its early stages to prevent it getting worse.

In the early stages, it may be controlled with medicine. Surgery may be required in severe or persistent cases.

Antibiotics

If you have lumps that are particularly painful, inflamed and oozing pus, you may be prescribed a 1- or 2-week course of antibiotics, if test show that you have a bacterial infection.

If bacterial infection is not present, low doses of antibiotics may be used to prevent inflammation. This longer course of antibiotics will last at least 3 months, to reduce the number of lumps that develop.

You may be given antibiotics as a cream (topical) or as a tablet, capsule or liquid. Antibiotic types can include lymecycline, doxycycline, erythromycin or clarithromycin.

In severe cases of hidradenitis suppurativa, a combination of clindamycin and rifampicin can be effective.

Antiseptics

Antiseptic washes, such as 4% chlorhexidine, applied daily to affected areas are often prescribed alongside other treatments.

Retinoids

Retinoids, such as acitretin, are vitamin-A based medicines that help some people with hidradenitis suppurativa.

Retinoids are always prescribed by dermatologists. They must be used with caution and cannot be taken during pregnancy. It’s also important to avoid getting pregnant for 3 years after stopping treatment, so they’re not usually prescribed if there’s a chance you could get pregnant.

Contraceptives

If hidradenitis suppurativa flares up before a period you may benefit from taking oral contraceptives.

Immunosuppressive treatments (infliximab and adalimumab)

In severe cases of hidradenitis suppurativa, treatments that suppress the immune system, such as adalimumab or infliximab, can be useful.

However, there are risks associated with suppressing the immune system, so they are usually only prescribed by a dermatologist if other treatments do not work.

Infliximab and adalimumab are immunosuppressive treatments that are given by injection at regular intervals either at home or in hospital.

Steroids

Rarely, you may be prescribed steroids, such as prednisolone, to reduce severely inflamed skin. Steroids can be taken as skin creams or tablets, or you may have an injection directly into affected skin.

Possible side effects of steroids include weight gain, poor sleep and mood swings.

Read more about steroid creams (topical corticosteroids), steroid tablets and steroid injections.

Surgery

Surgery may be considered in cases where hidradenitis suppurativa cannot be controlled with medicine.

Lifestyle advice

If you have hidradenitis suppurativa you should:

• lose weight if you are overweight
• stop smoking if you smoke
• use an antiseptic skin wash or antiseptic soap – this may be prescribed alongside other treatment
• hold a warm flannel on the lumps to encourage the pus to drain
• wear loose-fitting clothes
• avoid shaving affected skin

Outlook

Although hidradenitis suppurativa can persist for many years, if it’s diagnosed early the symptoms can be improved with treatment.

However, the condition can have a significant impact on a person’s everyday life. Having to regularly change dressings and constantly live with the pain and discomfort of the symptoms can affect your quality of life and lead to depression.

Speak to a GP if you’re finding it difficult to cope.

Page last reviewed: 17 March 2023
Next review due: 17 March 2026

Causes, home remedies, and prevention

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A vaginal boil is a pus-filled lump that develops outside the vagina due to a blocked hair follicle or oil gland.

While boils can occur in any area of the body, they are commonly found outside the vagina, on the labia, or in the pubic area.

Some people may use the term boil and abscess interchangeably to describe a vaginal boil. However, abscesses are usually deeper skin infections than boils.

Some skin conditions can be similar to a vaginal boil. While most will heal on their own, others may require medical attention to avoid a worsening infection.

Fast facts on vaginal boils:

• They often begin as a skin irritation that becomes infected with bacteria that naturally live on the skin.
• If the boil is filled with pus and appears severely infected, a doctor may drain the boil using a special sterile needle.
• When a person develops a vaginal boil or boils, they can try several home remedies to help the boil resolve.

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Share on PinterestVaginal boils may be caused by many different conditions.

There are a variety of conditions and factors that can cause vaginal boils.

Infectious organisms

Boils can be caused by bacteria, such as Staphylococcus aureus, Escherichia coli, and Chlamydia trachomatis.

Skin conditions

One skin condition that can cause vaginal boils is folliculitis, which occurs when bacteria infect a hair follicle.

This infection is often a side effect of irritation caused by shaving or waxing hair from the pubic area. A bump may be painful and start small but can grow larger and into a boil.

Cysts

Another common cause of a vaginal boil is a Bartholin gland cyst. This type of cyst is caused by an infection of the Bartholin glands, which are located under the skin near the vaginal opening. These glands can become blocked, causing a cyst or round, hard bump to form. If the cyst becomes infected, it can cause a boil to form.

Sexually transmitted infections

Sexually transmitted infections and genital piercings can also be underlying causes of vaginal boils.

Women with oily skin or those with thicker pubic hair growth are more at risk for vaginal abscesses, according to The Royal Women’s Hospital.

There are a range of home remedies that a woman can try. These include:

Applying warm (not hot) compression

Run a soft washcloth under warm water and apply the warm compress to the vaginal boil for 10 to 15 minutes. This may cause the boil to leak some pus. A person should not squeeze the boil.

Using a sitz bath

A sitz bath can be purchased online or at most drugstores as a plastic ring that can be filled with warm water and placed over a toilet bowl. Another option is to sit in a shallow bath filled with lukewarm water.

Keeping the area clean and dry

Wash the boil with antibacterial soap, clean the soap off using clean water from a spray bottle, and dry the affected area gently with a soft washcloth. Avoid rubbing or touching the boil. Always wash the hands with soap and water before cleansing or applying any topical antibiotic ointments to the area.

Wearing breathable underwear

Clean, cotton underwear can allow the skin to “breathe.” Women should avoid wearing tight underwear that can rub against the boil and inflame it.

Taking over-the-counter pain relievers

If the boil is mildly painful, a woman can take an over-the-counter pain reliever, such as acetaminophen or ibuprofen. If these medications do not control the pain, the woman should see her doctor.

Home treatments to avoid

Just as some at-home treatments can be beneficial, there are others that can be irritating or cause further damage.

A woman should never attempt to prick or squeeze a vaginal boil on her own. If the area is draining, she should cover it with a clean, dry bandage.

She should also avoid using any lotions, baby wipes, or ointments that are highly fragranced.

If the boil fails to respond to at-home treatments or over-the-counter medications or seems to be getting worse instead of better, a woman should seek medical attention.

A woman should also seek treatment if she observes any signs of infection, such as blood-streaked pus or the boil or surrounding skin is hot to the touch. The woman must also see her doctor if she develops any signs of a systemic infection, such as fever.

Draining the boil is effective for the most severe boils. A doctor may apply an antibiotic ointment and apply a sterile bandage to allow the boil time to heal.

Boils that are deeper in the skin or show signs of cellulitis, a bacterial infection affecting the inner layers of the skin and the fat layer, may require treatment with oral or intravenous (IV) antibiotics. The type of antibiotic prescribed depends on the nature and severity of the person’s infection.

Share on PinterestMaintaining a healthy weight is recommended to help prevent vaginal boils.

Changing underwear frequently and practicing excellent hygiene can help to prevent vaginal boils.

Keep the area clean by washing the body and vaginal area at least once a day with antibacterial soap.

Regular hand-washing can also help to reduce bacterial exposure.

However, practicing careful hygiene does not guarantee that a woman will not develop a vaginal boil.

Other preventive tips include:

• Maintaining a healthy weight can prevent additional skin folds developing, which can increase the risk of infection.
• Refraining from sharing personal items including towels and underwear can reduce the risk of infection.
• Changing into clean underwear after exercising can help prevent infection.
• Avoiding highly fragranced soaps, dyes, douches, and powders because these can irritate the tissues in the vaginal area and increase the risk of infection.

If a woman experiences chronic vaginal boils, she should talk to her doctor about further preventive options. For example, a doctor may prescribe birth control pills to reduce the amount of oil-producing hormones that can contribute to infections.

Ideally, a boil will shrink in size over the course of a week. If a women’s vaginal boil does not improve with at-home treatments, she should seek medical attention to keep the infection from spreading more deeply.

symptoms, diagnosis, treatment of bartholinitis, cysts or abscess of the Bartholin gland – Department of Gynecology – State Hospital NCC No. 2 (CCH RAS)

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Bartholinitis (abscess of the Bartholin’s gland, Bartholin’s cyst) – a disease in which the Bartholin’s glands become inflamed. These glands are located on both sides of the vagina in the region of the labia minora (on the eve of the vagina). Their main function is to maintain the moisture of the entrance to the vagina during intercourse. The excretory ducts of the glands open to the surface of the labia minora. When the ducts are infected (sexually transmitted infections – gonorrhea, trichomoniasis and chlamydia, less often – gonococci, streptococci, staphylococci, Escherichia coli and other microorganisms), their inflammation occurs, which can later spread to the entire gland and surrounding tissues. In most cases, only one gland becomes inflamed, i.e. the inflammatory process is unilateral.

Causes of development of bartholinitis – infection through the excretory ducts of the Bartholin glands. It contributes to:

• Poor hygiene of the genitals;
• Unprotected sex;
• Sexual contact during menstruation;
• The presence of diseases such as colpitis, urethritis, the presence of sexually transmitted diseases;
• Reduced immunity.

Symptoms of acute bartholinitis

• Swelling and redness on the labia minora;
• Appearance of a lump on the labia minora; compaction is painful when pressed;
• Swelling and hardening of the labia majora on the side of inflammation;
• Discomfort and pain in the labia while walking, intercourse, contact with clothing;
• Fever;
• Enlargement of lymph nodes in the groin.

Bartholinite forms

Depending on the volume and localization of the affected area, such forms of bartholinitis are distinguished as:

Canaliculitis – the infection got into the excretory duct of the gland and caused its inflammation, there are no pronounced symptoms

Bartholin’s gland cyst – with a clogged excretory canal, the secretion of the gland accumulates in the formed cavity due to the lack of outflow, there is no suppuration of the tissues of the gland itself and the surrounding tissue.

Abscess of Bartholin’s gland – tissues of Bartholin’s gland and surrounding cellular tissue are involved in the inflammatory process.

Chronic bartholinitis

In the chronic form, the disease periodically worsens under the influence of factors such as hypothermia, decreased immunity, menstruation, etc. Outside of exacerbation, mild pain from the affected gland, discomfort during intercourse may appear. During the period of exacerbation, symptoms similar to those of acute bartholinitis occur.

Diagnosis of bartholinitis

Diagnosis is based on examination data. At the same time, to select the most effective treatment, the doctor may prescribe such studies as a general blood test, urine; examination for urogenital infections, laboratory examination of the secretion of the Bartholin gland or pathological discharge from it, and others.

Treatment of bartholinitis

In most cases, after determining the cause that caused the development of bartholinitis, antibacterial therapy is selected taking into account the sensitivity of microorganisms to antibiotics, the inflamed area is treated with antiseptic agents, and a course of physiotherapy can be prescribed.

Treatment of an abscess of the Bartholin gland is predominantly surgical – an opening, drainage and treatment of the cavity is performed, if necessary, drug therapy is prescribed. Gynecologists at the NCC No. 2 (Central Clinical Hospital of the Russian Academy of Sciences) will select the most effective and quick treatment for bartholinitis. Treatment of a Bartholin gland cyst is also mainly surgical, outside the period of exacerbation.

Removal of cysts of Bartholin’s gland and Opening of abscess of Bartholin’s gland is possible in a day hospital (without daily hospitalization).

Inguinal purulent funiculitis. Review of clinical observations

The term funiculitis refers to inflammation of the membranes, fiber and elements of the spermatic cord (vas deferens, blood and lymph vessels, nerves) caused by banal or specific microflora [1, 2]. Currently, this term has become broader and includes many acute and chronic inflammatory diseases of the spermatic cord of various (autoimmune, infectious, pseudotumor and parasitic) nature, differing in clinical manifestations, course and prognosis [3, 4]. Funiculitis is often combined with inflammation of the vas deferens (deferentitis) and may be its complication (or vice versa), which confuses the terminology of these diseases [2].

BRIEF REVIEW. RELEVANCE

Inguinal purulent funiculitis (PGF) is a rare, insufficiently studied and unfamiliar disease for a wide range of surgeons, urologists and radiologists. This pathology was first described by N.R. Smith in 1834 as inguinal phlegmon of unclear etiology [2]. According to K. Eddy et al., in the English-language literature for the period from 1933 to 2011. only 4 cases of PHF are described [5, 6]. In total, 12 cases of PHF have been reported in the literature in patients of different ages, predominantly middle-aged and elderly [2-11].

The etiopathogenesis of PHF remains unexplored. PHF is considered as a phlegmon or abscess of the spermatic cord [2, 7], as a segmental infected dilatation of the inguinal part of the vas deferens [8], as a purulent vasitis (resp. , deferentitis) [3-6, 9-11]. It is assumed that PHF is caused by aerobic and anaerobic pyogenic flora, Mycobacterium tuberculosis, Pfeiffer’s Haemophilus influenzae, fungi. In most cases, the causative microflora and the source of infection at the time of clinical manifestation of PHF cannot be identified, which is considered as one of the features of this disease [11]. In this regard, it has even been proposed to refer to the disease as idiopathic PHF [2]. It is believed that the way the infection spreads to the membranes of the spermatic cord is hematogenous [2-6].

PHF affects the inguinal part of the spermatic cord [2-11]. PHF occurs in two clinical and pathomorphological forms (in the form of phlegmon and abscess of the spermatic cord), proceeds as an acute surgical disease and can be the cause of diagnostic errors, simulating a strangulated inguinal hernia, an abscess of the anterior abdominal wall, or an acute disease of the scrotum [3-6, 10 , eleven].

In the diagnosis of PHF, many authors noted the high efficiency of computed tomography (CT), which, in the literature observations presented, made it possible to identify phlegmon or abscess of the spermatic cord before surgery and exclude other acute surgical diseases, in particular, strangulated inguinal hernia [5, 6, 8- 14].

Treatment of PHF is only surgical (by percutaneous puncture and aspiration of the abscess of the spermatic cord under ultrasound navigation or by open surgery – revision and drainage of the membranes of the spermatic cord – with its phlegmon) [8-10]. With timely surgical treatment, the prognosis of the disease is favorable. A lethal outcome due to sepsis was observed in 3 (25%) of the described cases of PHF [2].

The prognosis for PHF may be different and depends on the clinical and pathomorphological form of the disease, the timeliness of diagnosis and treatment, as well as the immunoreactivity of the organism. In immunocompromised patients, PHF is characterized by a septic course and leads to death [2, 5, 6]. In patients of reproductive age, the course of PHF may be complicated by an excretory form of infertility due to the development of stricture or obliteration of the vas deferens as a result of inflammation [1, 2].

Over a 20-year period (from 1994 to 2014), two cases were observed in the City Clinical Urological Hospital No. 47 and the City Clinical Hospital No. 57 of the Moscow Healthcare Department, working in the emergency urological care mode. PHF, which caused serious diagnostic difficulties. We present these observations as an illustration.

CASE STUDY No. 1

Patient K., 42 years old, in September 2009 was admitted to the clinic for urgent indications with a referral diagnosis: acute left-sided epididymo-orchitis, hydrocele on the left. Complains of enlargement and soreness of the left inguinal region and the left half of the scrotum, hyperthermia up to 38° C with chills for 1.5 weeks, weakness, sweating. I fell seriously ill. The disease is associated with hypothermia. In history, he suffered repeated urogenital infections (gonorrhea, trichomoniasis), in childhood – an orchiectomy on the right side due to inguinal cryptorchidism, which led to testicular atrophy. Tuberculosis, HIV, hepatitis B and C denies. The general condition of moderate severity, due to inflammatory intoxication. Body temperature – 37.5 ° C. Correct physique, normal nutrition. The skin is pale with an earthy tint. No pathological abnormalities were found in the internal organs and organ systems. BP – 130/70 mm. rt. Art., pulse – 92 bpm On examination, there was an increase in the left inguinal region and the left half of the scrotum. The skin of the left inguinal region is hyperemic, edematous, the local temperature is elevated. In the projection of the left inguinal canal, an ovoid-shaped taut-elastic and sharply painful formation 7×3 cm is palpated, limited by the anatomical boundaries of the inguinal canal. The color of the skin of the scrotum and the local temperature are not changed, the folds of the skin of the left half of the scrotum are somewhat smoothed. The left testicle, epididymis and scrotal part of the spermatic cord were not changed on palpation. There is a slight accumulation of fluid in the membranes of the left testicle (hydrocele). The right testicle in the scrotum is not defined (removed). No pathological discharge from the urethra was noted. On digital rectal examination, the rectum, prostate gland, seminal vesicles and ampullar sections of the vas deferens were not changed. Blood tests revealed moderate anemia (hemoglobin – 108 g/l, erythrocytes – 4.0×106), leukocytosis up to 16×103, a shift in the blood formula to the left to young forms, an increase in ESR to 43 mm/hour. No pathological changes were found in urine tests. Chest x-ray showed no focal infiltrative changes in the lungs, diffuse enhancement and deformity of the lung pattern (chronic bronchitis “smoker”). Ultrasound examination (ultrasound) in the projection of the left inguinal canal revealed a liquid heterogeneous formation of a “cigar-shaped” shape 9, 5×3.5×4.2 cm (280 cm3), completely occupying the inguinal canal and limited by its walls, pushing back the elements of the spermatic cord (Fig. 1, 2, 3, 4). Magnetic resonance imaging (MRI) was performed, which confirmed the ultrasound data and additionally revealed a high protein content in the effusion of the left inguinal canal, which indicated its purulent nature (Fig. 5, 6). Differential diagnosis was carried out between a festering cyst (as the most likely diagnosis) and a hematoma (as the least likely diagnosis) of the spermatic cord. An exploratory revision of the inguinal canal confirmed the presence of a purulent cystic formation of the spermatic cord, which was opened, excised and drained. About 250 ml of thick pus was evacuated, the walls of the inguinal canal and the membranes of the spermatic cord were saturated with pus, thickened and compacted. During the operation, a possible suppuration of a congenital funiculocele was suggested. Histopathological examination revealed a pattern of diffuse purulent inflammation of the membranes and fiber of the spermatic cord. When sowing purulent contents, the growth of the flora was not detected. The outcome of the disease is recovery.

Fig. 1. Case No. 1. Patient K., 42 years old. Panoramic longitudinal echogram of the left inguinal-scrotal area. 1 funiculopiocele occupying the entire inguinal canal, 2 – intact testis and epididymis, 3 – small hydrocele

2. The same patient. Targeted ultrasound of the left inguinal region. 1 – funiculopiocele, 2 – unchanged funicular part of the vas deferens

3. The same patient. Transverse echogram of the inguinal canal on the left in the middle third. 1 – funiculopiocele, 2 elements of altered spermatic cord

Fig. 4. The same patient. Doppler angiogram of the spermatic cord on the left in the middle third of the inguinal canal. 1 – funiculopiocele, 2 – vessels of the spermatic cord

5. The same patient. MRI. Front cut. A – T1VI, B – T2VI. 1 – funiculopiocele on the left, 2 – hydrocele on the left, 3 – the right testicle is absent in the scrotum (removed)

6. The same patient. MRI. T2VI. Axial section at the level of the middle third of the inguinal canal on the left. 1 – funiculopiocele, 2 – spermatic cord

CASE STUDY No. 2

Patient S., 63 years old, in August 2010, due to T1N0M0 prostate cancer, underwent radical prostatectomy. The early postoperative period was complicated by a festering pelvic lymphocele with a volume of 650 ml, which was drained by an open method. Wound healing by secondary intention. He was discharged on the 24th day after the operation in a satisfactory condition. 1 month after discharge, he was admitted to the clinic again with complaints of enlargement and soreness of the left inguinal region and the left half of the scrotum, hyperthermia up to 38° with chills for 5 days. The general condition of moderate severity, due to purulent-inflammatory intoxication. In the left inguinal region, a motionless, rigid, and sharply painful formation 10x4x3 cm is palpated, the skin above it is edematous and hyperemic (Fig. 7). Acute epididymo-orchitis and strangulated inguinal hernia were excluded during clinical and echographic examination. The suggestion of an inguinal lymphocele was also rejected, since no dissection of the inguinal lymph nodes was performed during the previous operation. Ultrasound of the inguinal canal on the left revealed an encysted accumulation of heterogeneous fluid in the membranes of the spermatic cord (Fig. 8). Preliminary diagnosis: acute inguinal funiculitis with the development of reactive (inflammatory) funiculopiocele. During the revision of the inguinal canal and spermatic cord, about 150 ml of intershell purulent exudate was evacuated, thickening and thickening of the walls of the inguinal canal and membranes of the spermatic cord was noted. Histopathological examination of the resected membranes of the spermatic cord revealed signs of acute purulent diffuse inflammation (Fig. 9). When sowing the contents of the membranes of the spermatic cord, the growth of the flora was not detected. The outcome of the disease is recovery. The patient was discharged on the 20th day after the operation in a satisfactory condition with a healed wound. Ultrasound examination 2 weeks after the operation showed restoration of the structure of the spermatic cord and the walls of the inguinal canal (Fig. 10).

Fig. 7. Case No. 2. Patient S., 61 years old. Asymmetric enlargement of the right groin and scrotum (arrow). Hyperemia of the skin of the scrotum and inguinal region on the right. Right-sided inguinal funiculitis

Fig. 8. The same patient. Panoramic longitudinal echogram of the right inguinal-scrotal region. 1 funiculopiocele simulating an inguinal hernia, 2 intact testis and epididymis, 3 hydrocele, 4 abdominal cavity

9. The same patient. Micropreparation of the membranes of the spermatic cord. Hematoxylin and eosin. Magnification: x 100. Foci of polymorphonuclear leukocyte and eosinophilic infiltration (1) with hemorrhage foci (2). Acute purulent funiculitis

Fig. 10. The same patient. 14th day after the operation – opening and drainage of the phlegmon of the spermatic cord on the right. Panoramic longitudinal echogram of the right inguinal-scrotal region. Restoration of the structure of the spermatic cord and inguinal canal. 1 – spermatic cord, 2 – testis, 3 – hydrocele, 4 – abdominal cavity PHF clinically simulated various acute diseases of the inguinal-scrotal region: from acute purulent epididymo-orchitis to festering hematoma of the spermatic cord. The final verification of the disease belonged to intraoperative and pathomorphological research methods.

The etiopathogenesis of PHF in the presented two cases remains unclear. In the 1st case, given the history of anomalies of the genital organs (cryptorchidism), repeated urogenital infections and the results of an exploratory revision of the inguinal canal, suppuration of a congenital funiculocele against the background of a latent infectious deferentitis can be assumed as a pathomorphological substrate for PHF. As is known, congenital incomplete obliteration of the vaginal process of the peritoneum (processus vaginalis peritoneae Halleri) occurs in approximately 20% of children and can cause the development of funiculocele complicated by suppuration [12].

In the 2nd case, the occurrence of PHF was more likely to be preceded by pelvic purulent cellulitis and pelvic pyolymphocele, which arose as a complication of radical prostatectomy. It is known that complications of radical prostatectomy are not uncommon: in every 4th – 5th patient [13]. Among them, purulent-inflammatory diseases of the kidneys, urinary tract, scrotum organs and pelvic tissue occupy the first place, accounting for 40–60% of all postoperative complications [13, 14]. At the same time, the most probable pathway for the spread of a purulent infection from the bed of the removed prostate gland to the membranes of the spermatic cord is well studied: along the fascial case of the vas deferens to the membranes of the spermatic cord along the continuation – per continuitatem with the formation of a funicolopyelocele [15].

Our observations showed a high diagnostic efficiency of high-resolution ultrasound (6-16 MHz) and MRI. Ultrasound played the main role, it made it possible to assess the nature of the volumetric lesion of the spermatic cord and to conduct a differential diagnosis with acute surgical diseases of the inguinal-scrotal region. MRI, in our opinion, is somewhat more accurate than ultrasound in assessing the prevalence of lesions of the spermatic cord, as well as in clarifying the nature of the effusion (pus, blood, lymph).

Treatment of PHF was surgical: revision of the inguinal canal, excision and drainage of the funiculopiocele. Surgical intervention was performed according to urgent indications for diagnostic and therapeutic purposes and in compliance with the principles of purulent surgery; Both patients recovered as a result of treatment.

PHF is proposed to be differentiated primarily from strangulated inguinal hernia and acute diseases of the scrotum (acute epididymitis and testicular torsion), as well as from hematoma, vein thrombosis and tumor of the spermatic cord, osteomyelitis of the pubic bones and symphysis [2-11]. In the differential diagnosis of PHF and acute diseases of the scrotum, the method of choice is gray scale ultrasound, supplemented by Doppler sonography; while when distinguishing between PHF and strangulated inguinal hernia, priority belongs to computed tomography (CT) [5, 6, 8]. For the diagnosis of a tumor or hematoma of the spermatic cord, the use of MRI and high-resolution ultrasound is effective, for osteomyelitis of the pelvic bones, the use of pelvic radiography and CT [2, 5, 6]. In our observations, the use of a complex radiation examination, including high-resolution ultrasound (6-16 MHz) and MRI of the inguinal-scrotal region, made it possible to speak about the nature of the disease of the spermatic cord and choose the necessary treatment tactics.

CONCLUSION

Inguinal purulent funiculitis is an extremely rare disease with unknown etiopathogenesis. One of the likely mechanisms for the development of PHF is the suppuration of a congenital funiculocele or the development of an acquired funiculopiocele on the background of a urogenital infection or pelvic purulent cellulitis. A causative infection, presumably from the urethra, prostate, seminal vesicles and pelvic tissue, spreads to the membranes of the spermatic cord along the lumen of the vas deferens (canalicular way) or along its fascial sheath and further – from the vas deferens to the spermatic cord – along the continuation (per continuitatem) . PHF occurs as an acute surgical or urological disease and causes serious diagnostic difficulties. In the diagnosis of PHF, the use of high-resolution ultrasound and MRI of the inguinal canal and scrotum is effective. The final verification of the diagnosis is carried out by intraoperative and pathomorphological methods. PHF must be differentiated using radiation methods with acute diseases of the inguinal region, and above all, with strangulated inguinal hernia, acute epididymitis and testicular volvulus. Treatment of PHF should be surgical (revision of the inguinal canal, opening and drainage of the membranes of the spermatic cord). With timely diagnosis and treatment, the prognosis of PHF is favorable.

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