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[Clinical review of acute scrotum in children]
1Department of Urology, National Children's Hospital, Tokyo, Japan.
Insights
Acute scrotum in children poses diagnostic challenges. Torsion of the testicular appendage is the most common cause, but severe pain often necessitates surgical exploration for diagnosis and treatment.
Area of Science:
- Pediatric Surgery
- Urology
- Emergency Medicine
Context:
- Acute scrotum in children presents a frequent diagnostic dilemma.
- This study reviews the experience of managing acute scrotum in pediatric patients.
Purpose:
- To analyze the causes and outcomes of acute scrotum in children.
- To evaluate the diagnostic and therapeutic approaches for acute scrotum in pediatric patients.
Summary:
- A review of 40 pediatric cases (age < 15) diagnosed via surgical exploration revealed torsion of the testicular appendage (55%) as the most frequent cause of acute scrotum.
- Other diagnoses included spermatic cord torsion (35%), acute epididymitis (7.5%), and strangulated hernia (2.5%).
- While surgical exploration may not always be necessary for appendage torsion, severe or persistent pain often requires surgical intervention for definitive diagnosis and treatment.
Impact:
- Highlights the importance of accurate diagnosis in acute scrotum to prevent testicular loss.
- Provides insights into the age-specific incidence of different acute scrotum etiologies.
- Informs clinical decision-making regarding surgical intervention for acute scrotum in children.
Background:
The acute scrotum in children frequently presents a diagnostic dilemma. The objective of this study is to review the experience of patients with acute scrotum in children.
Methods:
From April 1986 until March 1998, we encountered 40 cases of acute scrotum in children less than 15 years old diagnosed by surgical exploration.
Results:
Final diagnoses consisted of 14 patients with torsion of the spermatic cord (35%), 22 patients with torsion of the testicular appendage (55%), 3 patients with acute epididymitis (7.5%), and patient with a strangulated hernia (2.5%). Of 22 patients with torsion of the testicular appendage, which were the most frequent cause of acute scrotum, 20 had torsion of the testicular appendix and 2 had torsion of the epididymal appendix. The age distribution of the patients with torsion of the spermatic cord was biphasic, with the highest frequencies occurring in patients 2 years old and 14 years old. In contrast, the age distribution of patients with torsion of appendage showed a single peak incidence at 9 years of age. Those with epididymitis were younger than 2 years old. Of 14 cases of torsion of the spermatic cord, orchiectomy was performed in 6 cases (42.9%) because of testicular necrosis.
Conclusion:
Although surgical exploration is no longer necessary for all patients with torsion of the appendage, this review revealed that patients complaining of severe or persistent pain usually require surgery to diagnose and treat the problem.
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