Acute Scrotal Swellings In Children, Presentation & Management

Abstract

Abstract: Background: The term acute scrotum refers to acute scrotal pain. This presentation should always be treated as an emergency because of the possibility of testicular torsion and permanent ischemic damage to the testis. It presents a major diagnostic and therapeutic challenge. Objectives: The study aimed to assess the presentation and management of acute scrotum in paediatric surgery. Methods: It is a prospective descriptive analytical study, conducted on three hospitals in the period from Mar. 2013 - Nov. 2014. It included all paediatric patients of acute scrotum younger than 13 years. Data was reviewed and analyzed using SPSS version 20. Final diagnosis was made by Doppler ultrasound ± surgical exploration in all cases. Results: the findings included epididymoorchitis (39.5%), testicular torsion (34.2%), torsion of testicular appendage (10.5%), scrotal abscess (6.6%), haematocele (5.3%) and obstructed inguinal hernia (3.9%). The common triad of symptoms was pain (100%), swelling (90.8%) and fever (46.1%), while the common triad of signs was tenderness(96.1%), erythema (82.9%) and oedema (80.3%).Surgical exploration was performed in 49 patients (64.5%), findings were testicular torsion (n=26), torsion of testicular appendage (n=8), epididymoorchitis (n=7), scrotal abscess (n=5) and obstructed inguinal hernia (n=3). In testicular torsion group, salvage rate was 38.5% (n=10), in most of patients (90%) operated within 24 hours from symptoms onset, however, most patients underwent orchiectomy (n=15) were operated after 24 hours (P value 0.000). Conclusion: Although epididymoorchitis is the most common cause of acute scrotum in paediatric, testicular torsion is the most important differential diagnosis since delay in management leads to testicular loss. Unfortunately, testicular torsion cannot be consistently confirmed or rule out by history and clinical examination.