Abstract |
A 47-year-old man with end-stage renal disease due to
diabetic nephropathy underwent a peritoneal
scintigraphy to evaluate the cause of recently
developed scrotal swelling. Two liters of dialysate
mixed with 111 MBq of Tc-99m sulfur colloid were
administered into the peritoneal cavity via the
dialysis catheter. Various anterior images of the
abdomen and pelvis were obtained at 15 min, 2 hr and 4
hr after the tracer instillation. At 15 min, anterior
images of the abdomen and pelvis demonstrated linear
tracts of activity through both inguinal canals, which
were more prominent in the right side (A). Images at 2
hr revealed a passage of the radioactive fluid into the
right hemiscrotum. At the same time, there was a
considerable accumulation of activity in the right
inguinal canal (B). In the delayed image, there was a
progressive accumulation of activity in the inguinal
canals and a prominent passage of the tracer into the
scrotum (C). Both abdominal and inguinal hernias are
commonly associated with continuous ambulatory
peritoneal dialysis (CAPD). Overall incidence of CAPD-
induced hernia ranges from 2.7% to 25%.1) Inguinal
hernias were frequently manifested as scrotal swelling.
Leakages of dialysate fluid into the scrotum has been
noted in CAPD patients with scrotal swelling, with or
without clinical findings of inguinal hernia.1,2) In
the present case, the right side had leakage from a
clinical inguinal hernia and the left side, leakage
from a subclinial inguinal hernia. A subclinical
inguinal hernia was easily demonstrable with peritoneal
scintigraphy. Peritoneal scintigraphy is extremely
helpful in the evaluation of scrotal swelling in a
patient on CAPD. (Korean J Nucl Med 2001;35:81-82) |