Rapidly Progressive Deep Polymicrobial Suprapubic Abscess Following Radical Inguinal Orchiectomy in a Patient With Poorly Controlled Diabetes

Radical inguinal orchiectomy is the gold standard surgical management for suspected testicular malignancy and is generally associated with low postoperative complication rates. Infectious complications are typically superficial and confined to the surgical incision or scrotal wall, while deep suprapubic or inguinal space abscess formation remains uncommon. We report a case of a 32-year-old man with poorly controlled type 2 diabetes mellitus who underwent a right radical inguinal orchiectomy for a testicular mass. On postoperative day 7, he developed mild inguinal swelling that was initially presumed to represent a benign hematoma. However, within days, he experienced worsening severe pain, erythema, leukocytosis, and systemic inflammatory response. Computed tomography of the abdomen and pelvis demonstrated a large loculated suprapubic fluid collection extending along the inguinal canal into the scrotum, concerning for a deep abscess. The patient underwent urgent incision and drainage with debridement and negative pressure wound therapy. Intraoperative cultures grew extended-spectrum-beta-lactamase-producing Escherichia coli and Actinomyces israelii, consistent with polymicrobial deep soft tissue infection. This case illustrates how seemingly benign postoperative changes may rapidly evolve into deep infection in high-risk patients, particularly in the setting of poorly controlled diabetes mellitus and hyperglycemia-associated impairment of host immune defenses. Furthermore, the anatomical continuity created by the inguinal approach may facilitate extension of infection beyond the superficial incision and along the spermatic cord tract. Radiographic findings may underestimate disease severity, and minimal gas does not exclude significant infection. Early operative source control and close clinical reassessment remain critical to preventing progression and optimizing outcomes in high-risk postoperative patients.