[Acute scrotum in children: analysis of 265 consecutive cases]

"Acute scrotum" in infants and children is generally due to testicular torsion, torsion of the appendix of testis or acute orchi-epididymitis. However they are other less frequent causes of "acute scrotum". The differential diagnosis is often very difficult. 265 consecutive cases of acute scrotum are reviewed. 47% of the all patients presented torsion of the appendix of testis, 26% torsion of testis and 26% acute orchi-epididymitis. The torsion of testis was most frequent in children under 1 year (67%), in the older patients the torsion of appendix of testis was most frequent (46% in patients 1-6 years old, 57% in patients over 6 years). The value and limit of ultrasound, scrotal scintigraphy and doppler ultrasound are discussed and an algorithm for the diagnosis of causes of acute scrotum is presented. In equivocal cases, early surgical exploration may be necessary to exsclude torsion of testis and to prevent testicular loss.