we report the case of a 25-year - old caucasian male who developed an acute right scrotum secondary to bile within peritoneal fluid that entered the scrotum through a previously undiagnosed communicating hydrocele . to the best of our knowledge , approximately 10 ml to 15 ml of bile was spilled during the procedure after inadvertent entry into the gallbladder during its dissection from the gallbladder fossa . after the gallbladder was removed , the abdomen was irrigated until aspirated fluid was clear . the right cremaster muscles were noted to be in spasm . a urologic consultation was obtained . the patient 's complaints and examination were concerning for testicular torsion , and right scrotal exploration was performed 3 hours after completion of the laparoscopic cholecystectomy . opening of the tunica vaginalis revealed 10ml of bile - stained fluid and a normal right testicle . the tunica vaginalis and right testicle were irrigated with saline , and a communicating hydrocele was identified and ligated . postoperatively , the patient noted immediate relief of pain , and examination revealed minimal tenderness in the right scrotum . the total bilirubin value of the fluid drained from the scrotum was 10 mg / dl . the patients ranged in age from 7 to 20 years of age and presented with symptoms between postoperative day 1 and 10 . acute postoperative scrotum due to early hernia recurrence has also been described in an infant after an open inguinal herniorrhaphy . yasumoto et al reported a case of a 10-year - old male who underwent open appendectomy for perforated appendicitis on postoperative day 1 following incision and drainage of a left scrotal abscess . infarction of the upper pole of the right testicle causing acute scrotal pain has been reported after a laparoscopic total extraperitoneal inguinal herniorrhapy . bile causes peritoneal signs on examination in some patients with cystic duct stump leaks after cholecystectomy . although the mechanism of irritation is not fully understood , bile salt concentration and bacteria are thought to be possible causes of bile - induced abdominal pain . the cause of acute scrotal pain in this case was due to bile within peritoneal fluid that entered the right scrotum through a communicating hydrocele . the fluid entered the right scrotum after spillage occurred while the patient was in a reverse trendelenberg position with increased intraperitoneal pressure due to carbon dioxide insufflation . the possibility of bile causing the patient 's pain was included in our differential diagnosis ; however , with no prior cases reported in the literature and our concern for testicular torsion , we felt urgent exploration was indicated . future management of a similar patient may include the option of percutaneous aspiration of the hydrocele with laboratory examination to determine bile concentration . if symptoms persist following aspiration , urgent scrotal exploration would be indicated to rule out testicular torsion . the surgical literature is scattered with only a handful of reported cases of an acute scrotum developing after laparoscopic procedures . an acute suppurative process associated with laparoscopic appendectomy is the most common cause described to date . the patient 's symptoms completely resolved after urgent scrotal exploration with drainage of bilious fluid that entered via a communicating hydrocele . to the best of our knowledge , this is the first case of an acute scrotum due to bile after laparoscopic cholecystectomy . as the volume of minimally invasive procedures performed increases , so does the number of unusual complications that develop . reporting of such uncommon disorders developing after minimally invasive procedures provides a reference that may potentially allow earlier recognition and treatment of similar complications by fellow surgeons in the community .
we report our experience with a patient that developed an acute right hemiscrotum immediately after undergoing an uncomplicated laparoscopic cholecystectomy for gallbladder dyskinesia . 
 the etiology of the acute scrotal pain was due to bile which was spilled into the peritoneum after entry into the gallbladder during dissection . 
 the bile obtained access to the right hemiscrotum via a communicating hydrocele . 
 to the best of our knowledge this is the first report of bile causing an acute scrotum following laparoscopic surgery . 
 a review of the current literature on the topic of the postoperative acute scrotum follows our case presentation .