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Meconium periorchitis – An uncommon cause of perinatal scrotal swelling

Meconium periorchitis is caused by the passage of meconium from bowel perforation into the scrotal sac. It is uncommon, with a reported incidence of one per 35 000 live births. The perforation occurs during late fetal life or in the early postnatal period. The typical presentation is a soft hydrocele at birth, which becomes firmer in weeks to months as the meconium calcifies. We report the case of a male infant, 38 weeks and 6 days gestation; born via emergency lower uterine segment caesarean section. At delivery, the paediatrician noted bilateral scrotal swelling. The left testis felt normal on examination, but there was no palpable right testis. A hydrocele was suspected; however, a lack of transillumination raised other possibilities – including hernia, neoplasm, torsion or birth trauma/haematoma. The ultrasound features, biochemical markers, plain film radiography and fluoroscopy collectively confirmed the diagnosis of meconium periorchitis. This case is unusual as it occurred in isolation, without associated cystic fibrosis, bowel atresia or volvulus.