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Early exploration in the management of acute scrotum in children
Ahmad Khaleghnejad-Tabari1, Alireza Mirshermirani, Mohsen Rouzrokh
1Pediatric Surgery Research Center, Mofid Children's Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran.
Insights
Acute scrotum in boys requires prompt surgical exploration for accurate diagnosis and management. Early intervention, guided by clinical examination, improves outcomes and avoids delays associated with diagnostic techniques.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Acute scrotal conditions are common in pediatric patients, presenting with pain and swelling.
- Timely diagnosis and management are crucial to prevent testicular damage and preserve fertility.
Purpose of the Study:
- To evaluate the clinical findings and outcomes of surgical management for boys diagnosed with acute scrotum.
- To analyze the common causes and diagnostic approaches in pediatric acute scrotum cases.
Main Methods:
- A descriptive study of 100 pediatric patients with acute scrotum admitted to a children's hospital over 14 years.
- Data collected included patient history, symptoms, diagnostic methods, surgical procedures, and outcomes.
Main Results:
- Testicular torsion (31%) and incarcerated inguinal hernia (30%) were the most frequent causes of acute scrotum.
- Pain and swelling were the predominant symptoms (62%); 80% of patients presented after 12 hours.
- Surgical exploration was performed in 83 patients, leading to accurate diagnoses and appropriate interventions like orchiopexy or orchiectomy.
Conclusions:
- Clinical examination and early surgical exploration are vital for accurate diagnosis of acute scrotum in children.
- Surgical exploration is a safe, effective procedure that allows for definitive diagnosis and timely treatment, minimizing risks of misdiagnosis and delay.
Objective:
Acute scrotal conditions are a common clinical setting that present with pain and swelling of the hemiscrotum. The aim of our study has been to evaluate the findings in boys operated on acute scrotum.
Methods:
A descriptive study was conducted on 100 patients with acute scrotum admitted to Mofid Children's Hospital from March 1993 to March 2007. Data included history, age, primary symptoms, definite diagnosis, side involvement, paraclinical tests, imaging modalities, medical or surgical management and type of the surgery.
Findings:
Diagnosis was made mainly by clinical signs and symptoms and surgical exploration. Torsion of testis (n=31) was the most common cause of acute scrotum followed by incarcerated inguinal hernia (n=30), torsion of testicular appendage (n=27), epididymo-orchitis (n=7), idiopathic scrotal edema (n=4) and hematocele (n=1). Most (34%) of the patients were in the first year of life and the mean age was 5.4 years. The commonest signs were pain and swelling (62%) followed by pain, swelling and redness (21%) and pain alone (16%). 83 patients consisting of 31 with torsion of testis, 14 with torsion of testicular appendage, 30 with incarcerated hernia and 7 with epididymo-orchitis underwent surgical exploration after careful physical examination. 10 of 31 patients with torsion of testis had orchiectomy and orchiopexy of contra-lateral testis and the rest had detorsion and bilateral orchiopexy. 80% of patients were referred to the hospital after 12 hours of clinical onset of symptoms.
Conclusion:
Early exploration of scrotum based on careful physical examination excludes the risk of misdiagnosis by diagnostic procedures and unnecessary delay by diagnostic techniques. Exploration of scrotum is a relatively safe and simple procedure with good cosmetic results, it also allows an accurate diagnosis to be made.
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