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

Necrotizing enterocolitis, surgical experience

Between January 1988 and December 1994,29 cases of necrotizing enterocolitis [NEC] required surgical management. There were 15 males and 14 females. The gestational age range was 24-38, average 32.7 weeks and body weight range was 565-4500 grams, average 1,680 grams. Necrotizing enterocolitis developed within two weeks of age in 55% of the cases, between two and four weeks in 34% and beyond four weeks in four cases [14%]. Pneumoperitoneum was the commonest indication for surgery [55%] of cases, followed by failure of response to medical treatment. The commonest surgical procedure was resection of the gangrenous bowel with creation of an enterostomy for the segmental disease in 15 cases [50%] and resection with primary anastomosis in six cases [20%]. Four cases [14%] had NEC totalis for which drainage alone was done, and two cases had external drainage alone. Survival rate was 72%