a 5-month-old infant with right scrotum swelling

case presentation: a five-month-old male infant (gestational age 28 weeks, birthweight 1020 gm) with posthemorrhagic hydrocephalus subsequent to prematurity had a left sided ventriculoperitoneal shunt 3 months after birth. frontal radiography of the chest and abdomen check-up after operation are shown in figure 1. he was referred to our emergency department with a history of right scrotal swelling for several days. physical examination, he appeared malnourished. he was afebrile. the right scrotum was found to be distended. bilateral testicles were palpable on both sides. there were no features of shunt malfunction. a complete blood cell count showed the following: leukocyte count, 7900/mm3; segmented neutrophils, 65%; hemoglobin level of 9.3 mg/dl; hematocrit, 25.9%; and platelet, 190000/ul. other laboratory studies included: glucose, 92 mg/dl; serum urea nitrogen, 10 mg/dl; serum creatinine, 0.2 mg/dl; sodium, 140 meq/l; potassium, 3.9 meq/l; c-reactive protein, 2.9mg/l; and prothrombin time with an international normalized ratio of 1.2. his abdomen x-ray is shown in figure 2.