A 5-day-old male neonate was transferred to our neonatal intensive care unit due to necrotizing enterocolitis. He was born at 38 weeks and 5 days of gestation via normal vaginal delivery, weighing 3,360 g. Before the transfer, his oral intake was poor, he was vomiting bile-colored contents, and his abdomen was distended. An emergent exploratory laparotomy was performed after an infantogram revealed pneumoperitoneum. A gastric perforation from the fundus to the mid-body along the lesser curvature was observed, and primary closure was performed. Right scrotal swelling and fever (up to 37.4°C) were noted 4 days after the surgery. Serum C-reactive protein (CRP) level was high at 5.08 mg/dL (range, <0.5 mg/dL); other laboratory findings were within normal limits. Ultrasonography revealed complex fluid collection in the right scrotum, accompanied by multiple amorphous calcifications (Fig. 1). Vascular flow between the right testis and spermatic cord was preserved. With an inguinal incision, high ligation of the patent processus vaginalis, and irrigation and drainage of the abscess were performed. Intravenous cefotaxime was injected. Because the swelling and redness of the scrotum persisted, we recognized a remnant abscess. Thus, 2 weeks later, we performed an additional scrotal incision and drainage due to the remnant abscess. After the second operation, intravenous cefotaxime was administered for 2 more weeks. Three weeks after the second incision and drainage, the patient was discharged without any other problems. Follow-up ultrasound examination after 6 months revealed no abnormal findings in the testes and scrotum.

A male neonate, born at 37 weeks and 1 day of gestation via normal vaginal delivery, weighing 3,290 g, was referred due to abdominal distension and scrotal swelling (Fig. 2). On prenatal ultrasonography, fetal ascites was found, and fetal bowel perforation was suspected. The next day, an explorative laparotomy was performed. Operative findings revealed ileal atresia and generalized peritonitis due to small bowel perforation. Small bowel segmental resection and anastomosis were performed. After the surgery, feeding intolerance did not improve and the scrotum, which collapsed immediately after surgery, gradually swelled the next day, leading to redness and a heating sensation. Vital signs, whole blood cell counts, and serum CRP levels were within normal limits. An upper gastrointestinal series and colon studies showed delayed contrast passage in the small bowel. Because passage disturbance at the anastomosis site or intestinal motility disorder was considered based on the contrast studies, loop ileostomy was planned. Ultrasonography revealed a complex right scrotal hydrocele with a patent processus vaginalis (Fig. 3). Scrotal exploration was performed with loop ileostomy. The patent processus vaginalis was closed on the peritoneal side. The complex fluid was removed using a scrotal incision, and a drainage tube was inserted. Methicillin-resistant Staphylococcus epidermidis and Enterococcus faecium were cultured from a pyocele. Intravenous vancomycin was administered. Two days after the surgery, the drainage tube was removed, and the pyocele had healed. Six months later, the patient underwent ileostomy repair and was discharged. He is scheduled to undergo surgery for a buried penis when he is 2 years old.

A 7-day-old boy presented with abdominal distension. He was born by cesarean section due to premature rupture of the membranes at 27 weeks and 5 days of gestation, weighing 1,151 g. After birth, respiratory distress syndrome and persistent pulmonary hypertension were diagnosed, and surfactant and nitrogen oxides were administered and tapered. After transfer, pneumoperitoneum was found on an infantogram; thus, an exploratory laparotomy was performed immediately. A perforation site in the stomach along the greater curvature from the gastroesophageal junction to the mid-body was found, and the perforation was repaired. Two weeks after the surgery, desaturation occurred. Serum CRP level was elevated to 4.11 mg/dL and Escherichia coli was cultured from the peripheral blood. Physical examination revealed left inguinal swelling. Ultrasonography revealed bilateral small patent processus vaginalis and a left inguinal abscess connected to the left patent processus vaginalis (Fig. 4). The abscess was aspirated (Fig. 5), and intravenous meropenem was administered. E. coli was also cultured from the abscesses. After 10 weeks, the patient was discharged without any complications, and an intact testis was confirmed on follow-up sonography.