A 12-year-old immunosuppressed boy presented with self-limiting abdominal pain, low-grade fever and progressive scrotal swelling. Relevant recent medical history included recurrent pneumatosis intestinalis secondary to bone marrow transplantation for relapsed non-Hodgkin lymphoma.

Abdominal radiograph (ESM Fig. 1) shows extensive bowel pneumatosis with evidence of retroperitoneal and scrotal gas. Pelvic CT (Fig. 1, CTDI = 8.99 mGy) shows widespread pneumatosis intestinalis with both peritoneal and retroperitoneal gas and marked surgical emphysema extending into the perineum and scrotal wall (scrotal emphysema, long arrow). Further intra-scrotal gas appears intimately related to the right testicle (scrotal pneumatocoele, dashed arrow).

Fig. 1
figure 1

Pelvic CT

Full size image

The term pneumoscrotum describes the presence of air in the scrotal soft tissues originating via one or more of three described routes [1]:

  1. 1.

    Scrotal emphysema: extraperitoneal air dissecting through fascial layers into the scrotal wall

  2. 2.

    Scrotal pneumatocoele: intraperitoneal air entering the scrotum via patent processus vaginalis [2]

  3. 3.

    Gas gangrene/local trauma: local production of scrotal gas/air