Occult Splenic Rupture Presenting as Acute Scrotal Swelling

Background: Scrotal pain and swelling is a common complaint encountered in emergency medicine. The differential diagnosis includes testicular, scrotal, and intra-abdominal pathology. Case Report: We present a case of an 80-year-old man on warfarin therapy presenting with acute atraumatic scrotal pain and swelling initially diagnosed as a hydrocele. The diagnosis was subsequently determined to be a communicating hematocele secondary to occult splenic rupture. Conclusion: Intra-abdominal pathology can result in scrotal pain and swelling due to passage of intra-abdominal contents into the scrotum via a patent processus vaginalis. Therefore, any cause of hemoperitoneum may also cause hematocele and hematocele should be considered in the differential diagnosis of acute scrotal swelling in any patient with risk factors for bleeding. In these patients, both scrotal and abdominal imaging should be considered.