Acute scrotum in children: Jordan university hospital experience

Introduction: acute scrotum is one of the common surgical emergencies in pediatric age group. Although the differential diagnoses are many, most of the conditions are not urgent; of paramount importance is the prompt diagnosis and surgical treatment of torsion of the test is to avoid permanent ischemic damage. In this study we present our experience at University of Jordan Hospital in management of acute scrotum in children

Methods: a retrospective review of the pediatric patients who were admitted to the pediatric surgical unit at Jordan University Hospital with acute scrotum from March 2008 to March 2013. The characteristics of symptoms, clinical and imaging findings prior to operation, operative findings and type of management were recorded

Results: a total of 59 patients with acute scrotum were admitted and constituted the basis of this study. Operative exploration was performed in all of the 59 cases: Four patients [7%] had testicular torsion, 28patients [48%] had torsion of testicular appendix, 13 patients [22%], had epididymo-orchitis, three patients had idiopathic scrotal edema; three patients [5%] had scrotal hematomas due to trauma; two patients[3%] had incarcerated inguinal hernias; two patients[3%] had hydroceles and four patients [7%] had normal findings

Conclusions: testicular torsion is a common surgical emergency in children which should be treated promptly with early scrotal exploration; since no diagnostic test in the pre-operative work up could differentiate between the different causes and excludes torsion testis which is the major concern. A prospective study to evaluate the diagnostic accuracy of Doppler ultrasonography is suggested based on the results of the predictive values seen in our study

Comparison between two types of surgical repair in primary distal hypospadias- Mathieu and Snodgrass

Perimeatal flap [Mathieu] and tubularized incised-plate urethroplasty [Snodgrass] methods were compared regarding postoperative complications and cosmetic appearance in primary distal. The medical records of 50 consecutive patients who had undergone repair of primary distal hypospadias by a single surgeon, between January 2002 and July 2004, were reviewed; their age ranged from 0.3 years to 9 years with an average of 3.2 years. Snodgrass-type repair was undertaken in 24 patients who are in a mean age of 3.3 years and with an age range of 0.3 to 9 years. Mathieu-type repair was undertaken in 26 patients who are in a mean age of 3.0 years and with an age range of 0.5 to 9 years. Patients with primary hypospadias either with or without minimal chordee were included in the study. The mean postoperative follow-up period was 6 months. Postoperative complications, namely fistulas, occurred in 4 patients [8.0%]; 3 in the Snodgrass group and one in the Mathieu group, the difference is not statistically significant [P value = 0.305]. The mean hospital stay was 6.5 days in the Mathieu group versus 8.1 days in the Snodgrass group, the difference is not significant [p value = 0.357]. The period of urinary diversion [duration of stenting the urethra] was 5.7 days in the Mathieu group versus 7.3 days in the Snodgrass group, the difference is not significant [p value = 0.232]. Cosmetic appeareance was more satisfactory in the Snodgrass group than in the Mathieu group in regard to the shape and location of the meatus, the shape of the glans and the skin coverage of the shaft of the penis. The Snodgrass method should be preferred for primary distal hypospadias with a normal urethral plate due to its satisfactory cosmetic appearance. However, when a healthy urethral plate is not available, Mathieu-type repair is preferred

Recurrent maturing perineal lipoblastoma

Lipoblastoma is a rare benign neoplasm of fetal adipose tissue that we see mostly in infants and young children less than 3 years of age. Most lipoblastomas occur on the extremities, trunk, head and neck, and various other organs have been described. We report a case of a recurrent perineal lipoblastoma in a 2.5-year-old boy, which showed maturation of the lipoblasts as compared to the primary tumor