A 27 year old male who presented to the Urology Clinic, Lily Hospitals Limited, Warri, Delta State, Nigeria with complaints of recurrent scrotal pains of 3 years duration and right iliac fossa pain of 2 years duration. Scrotal pain was insidious in onset, dull aching, does not radiate to any part of the body, not worse at any time of the day, no known aggravating or relieving factors, not associated with scrotal swelling, lower urinary tract symptoms, urethral discharge or haematuria. The right iliac fossa pain was insidious in onset, colicky, does not radiate to any part of the body, aggravated by strenuous activities and cough, no known relieving factors, not associated with fever, anorexia, nausea, vomiting or abdominal distension. There was no past history of surgery and he was not allergic to any medications.
Physical examination revealed right iliac fossa tenderness with positive Rovsing’s sign and bilateral grade 2 varicoceles.
Investigations requested were Scrotal Doppler ultrasound scan that revealed bilateral dilated pampiniform plexus of veins above 3millimeters in keeping with varicoceles(Fig. 1) Abdominal ultrasound scan that revealed sub-acute appendicitis(Fig. 2) Urinalysis that was normal with normal Full blood count, Serum electrolytes, urea and creatinine. The diagnosis of bilateral varicocele with subacute appendicitis was made.
He subsequently had bilateral Open Inguinal Varicocelectomy and Open Appendicectomy done by the Consultant Urologist and General Surgeon respectively at the same sitting under regional anaesthesia.
Intraoperative findings were bilateral dilated pampiniform plexus of veins and retroileal inflamed appendix measuring about 12 centimeters (Fig. 3) He had uneventful post-operative recovery and was discharged home 3 days after surgery. He is currently on follow up visit with complete resolution of both right iliac fossa pain and scrotal pain.
Histopathology report of the resected appendix revealed lymphoid follicular hyperplasia with no evidence of malignancy while that of the resected varicocele segment revealed features consistent with varicocele