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The incidence and investigation of acute scrotal problems in children

H F McAndrew1, R Pemberton, C S Kikiros

  • 1Department of Surgery, Great Ormond Street Hospital for Children, London WC1N3JH, UK.

Pediatric Surgery International
|November 5, 2002
PubMed

Insights

Torsion of the appendix testis is the most common cause of acute scrotum in children. Epididymo-orchitis is not rare in infants, but further urinary tract investigation is not always necessary.

Area of Science:

  • Pediatric Urology
  • Emergency Medicine
  • Surgical Pathology

Background:

  • The incidence of acute scrotum causes in children is not well-established.
  • Epididymo-orchitis (EO) is often considered uncommon in pediatric patients.
  • Urological investigations are frequently recommended for children diagnosed with EO.

Purpose of the Study:

  • To determine the incidence of pathologies causing acute scrotum in pediatric emergency department patients.
  • To evaluate the necessity of further urinary tract investigations in boys with EO.

Main Methods:

  • Retrospective review of 100 consecutive pediatric patients admitted for testicular pain.
  • Analysis of diagnoses including torsion of the appendix testis (TAT), torsion of the testicle (TT), and EO.
  • Review of microbiological cultures and urological investigation outcomes.

Main Results:

  • Torsion of the appendix testis (TAT) was the most frequent diagnosis (70 patients).
  • Torsion of the testicle (TT) occurred in 12 patients.
  • Epididymo-orchitis (EO) was diagnosed in 10 boys (11 episodes), with Escherichia coli cultured in 4; none had underlying urinary tract abnormalities.
  • Other pathologies included incarcerated hernia, varicocele, and idiopathic scrotal edema.
  • EO incidence in infants equaled that of TT.
  • No underlying urinary tract abnormalities were found in EO patients post-investigation.

Conclusions:

  • Torsion of the appendix testis is the most common cause of acute scrotum in children.
  • Epididymo-orchitis is not rare in infants and children, with an incidence comparable to testicular torsion in this study.
  • Routine urological investigation for all pediatric EO cases may not be necessary, though recommended in selected cases based on literature.

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