Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years

INTRODUCTION@#Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.@*METHODS@#A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.@*RESULTS@#Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.@*CONCLUSION@#There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.

Guía de Práctica Clínica sobre el síndrome de escroto agudo

RESUMEN El síndrome de escroto agudo es una urgencia quirúrgica, que si no se hace una evolución adecuada y existen demoras en el diagnostico puede el paciente tener daños irreversibles en la viabilidad testicular. Se presenta la Guía de Práctica Clínica sobre el síndrome de escroto agudo con el objetivo de hacer una actualización sobre el tema y proporcionar un instrumento asistencial y docente en los servicios de cirugía pediátrica del país. Varias enfermedades pueden ser la causa de aparición del síndrome de escroto agudo, entre ellas, la torsión testicular, la torsión de hidátides testiculares y la orquiepididimitis. El síntoma fundamental es el dolor testicular y requiere generalmente tratamiento quirúrgico. El tratamiento oportuno de estos pacientes evita complicaciones como la necesidad de orquiectomia, la esterilidad y reincorpora más rápidamente al paciente a su actividad social.

ABSTRACT Acute scrotum syndrome is a surgical emergency, which if an adequate evolution is not made and there are delays in the diagnosis, the patient can have irreversible damage in the testicular viability. The Clinical Practice Guidelines on acute scrotum syndrome is presented with the aim of updating the subject and providing a care and teaching instrument in the pediatric surgery services of the country. Several diseases can be the cause of the onset of acute scrotum syndrome, including testicular torsion, testicular hydatid torsion, and orchiepididymitis. The fundamental symptom is testicular pain and usually requires surgical treatment. The timely treatment of these patients avoids complications such as the need for orchiectomy, sterility, and that way the patient is more quickly reincorporated into his social activity.

Acute appendicitis mimicking acute scrotum: a rare complication of a common abdominal inflammatory disease / Apendicite aguda mimetizando escroto agudo: uma complicação rara de uma doença inflamatória abdominal comum

ABSTRACT Introduction: Acute appendicitis is the most common surgical disease of the abdomen in clinical practice, affecting mainly young adults. It has a wide variety of clinical presentations, due to the anatomical variation of the cecal appendix. Its presentation as acute scrotum and scrotal abscess is quite rare and atypical, occurring mainly in young male patients with patent processus vaginalis. Case presentation: An 18-years-old male patient attended the emergency unit complaining of diffuse abdominal pain, fever and hyporexia for four days followed by inflammatory signs in the scrotum. He was taken to the operation room after diagnosis of scrotal and abdominal sepsis. During scrotum exploration, pus was found inside the right hemiscrotum coming down from the groin and communicating with the abdominal cavity. The laparotomy found perforated appendicitis and peritonitis leading to the scrotal abscess. The abscess was drained, appendectomy was performed and the scrotal and abdominal cavity were washed with saline solution. Despite postoperative complications such as pneumonia and intra-abdominal abscess, the reported patient recovered and was discharged in the 44th postoperative day. Conclusion: Acute appendicitis can mimic acute scrotum and surgeons must have a high index of suspicion of this complication for diagnosing. This unusual clinical presentation may be challenging and can delay the diagnosis leading to perforated peritonitis.

RESUMO Introdução: A apendicite aguda é a doença cirúrgica mais comum do abdome na prática clínica, afetando principalmente adultos jovens. Tem uma grande variedade de apresentações clínicas, devido à variação anatômica do apêndice cecal. Sua apresentação como escroto agudo e abscesso escrotal é bastante rara e atípica, ocorrendo principalmente em pacientes jovens do sexo masculino com túnica vaginalis patente. Apresentação do caso: um paciente do sexo masculino de 18 anos de idade compareceu à unidade de emergência queixando dor abdominal difusa, febre e hiporexia por quatro dias que se seguiram de sinais inflamatórios no escroto. Ele foi levado para centro cirúrgico após o diagnóstico de sepse de origem escrotal e abdominal. Durante a exploração da bolsa escrotal, secreção purulenta foi encontrada do lado direito oriunda do canal inguinal e comunicando-se com a cavidade abdominal. Durante a laparotomia observou-se sinais de apendicite aguda perfurada e peritonite levando ao abscesso escrotal. O abscesso foi drenado, a apendicectomia foi realizada e as cavidades escrotal e abdominal foram lavadas com solução salina. Apesar de complicações pós-operatórias como pneumonia e abscesso intra-abdominal, o paciente recuperou-se bem, recebendo alta hospitalar no 44° dia pós-operatório. Conclusão: A apendicite aguda pode simular o escroto agudo e os cirurgiões devem ter um alto grau de suspeição dessa complicação para o diagnóstico. Esta apresentação clínica incomum pode ser desafiadora e retardar o diagnóstico levando à peritonite por perfuração.

High-frequency ultrasonography for diagnosis and differential diagnosis of acute scrotum in children / 中华男科学杂志

<p><b>Objective</b>To analyze the high-frequency ultrasound image features of acute scrotum in children and explore the value of high-frequency ultrasonography in the diagnosis and differential diagnosis of the disease.</p><p><b>METHODS</b>This retrospective study included 256 children aged 2 days to 14 years undergoing color Doppler ultrasonography at 2 hours to 3 days after onset of acute scrotum. We analyzed the morphology, internal echo and blood supply of the testis in comparison with the clinical and pathological results.</p><p><b>RESULTS</b>Among the 256 cases, acute testicular torsion was found in 23, of which 16 were treated by complete resection the necrotic testis and the other 7 by surgical reduction of testicular torsion. Ultrasonographically, the involved testes presented different degrees of increase or decrease in volume, with uneven internal echoes, irregular hypoechoic flakes, and testicular hydrocele. Color Doppler flow imaging (CDFI) showed significant blood flow signals around the diseased testes but none within them. Acute testicular appendix torsion was found in 116 cases, in which ultrasonography manifested nodules with round or oval abnormal echoes between the upper pole of the testis and caput epididymidis, first hypoechoic and then gradually increased, heterogeneous internally. CDFI revealed enlarged epididymides and enriched testicular blood flow but no blood flow signals in the nodules. The 103 cases of acute epididymitis were ultrasonographically characterized by varied degrees of swelling of the involved epididymis with uneven internal echoes and rich blood flow signals on CDFI. Six of the cases were diagnosed as acute orchitis, with the ultrasonographic features of testicular swelling and low but uniform internal echoes, with rich blood flow signals on CDFI. Incarcerated inguinal hernia was confirmed in 15 cases, in which ultrasonography revealed intrusion of the hernia into the obviously enlarged scrotal sac with the mesentery and intestine in it, and blood flow visible on CDFI. Acute scrotal wall hematoma and edema was found in 8 cases, with the ultrasonographic characteristics of scrotal wall thickening, with visible blood flow signals on CDFI.</p><p><b>CONCLUSIONS</b>High-frequency ultrasonography has a high sensitivity and specificity for acute scrotum in children, which can be applied as the first-choice clinical imaging modality and provide reliable evidence for the diagnosis and differential diagnosis of the disease.</p>

Lipomas intraescrotales en niños, un hallazgo casual excepcional / Intrascrotal lipomas in children-an exceptional unexpected finding

Los tumores paratesticulares en niños son poco frecuentes, y son diagnosticados de forma incidental al realizar una ecografía en el contexto de un escroto agudo o un traumatismo. Su exéresis debe realizarse vía inguinal, ante la posibilidad de su malignidad. Se presentan dos casos de tumor paratesticular hallados incidentalmente, cuyo diagnóstico histopatológico confirmó que se trataba de lipomas intraescrotales.

Paratesticular tumors are rare in children and are diagnosed by chance on echography of an acute scrotum or a trauma. It should be excised by the inguinal route to prevent any possibility of malignancy. Here are two cases of paratesticular tumors which were randomly found. The final histopathological diagnosis confirmed that they were intrascrotal lipomas.

Establishment of predictive model of testicular torsion in pediatric patients with acute scrotum / 中华实用儿科临床杂志

Objective To establish a predictive model of testicular torsion according to the clinical data of pediatric patients with acute scrotum.Methods Retrospective study was performed to analyze medical records of 118 pediatric patients with acute scrotum.A case-control study was conducted,the case group included the patients with testicular torsion and the control group included the patients without testicular torsion.Data of patients including physical signs and laboratory tests related to testicular torsion were assessed by univariate analysis through Chi-square test or t test.All factors which had statistical significance in the univariate analysis were used as independent variables for multivariate Logistic analysis to establish a predictive model of pediatric testicular torsion.Results There were 54 patients in the case group and 64 patients in the control group.Vanishment of cremaster reflex,duration of pain,fever,urine positive and fading away of color Doppler flow imaging (CDFI) were independent predictors of pediatric testicular torsion (all P ＜ 0.05),and the OR values were 4.330,0.888,0.229,0.107 and 4.408,respectively.The predictive model of testicular torsion in pediatric patients was as follows:In [P / (1-P)] =2.307 + 1.466 × vanishment of cremaster reflex-0.119 × duration of pain-1.476 × fever-2.235 × urine positive + 1.484 × CDFI.Conclusions The Logistic regression model,which takes into account vanishment of cremaster reflex,duration of pain,fever,urine positive and CDFI,can be used to predict the risk factors of pediatric testicular torsion to provide a basis of surgical exploration.

Migración errática de Ascaris lumbricoides a escroto / Erratic migration of Ascaris lumbricoides to scrotum

Introducción. La ascaridiasis es una de las principales parasitosis que afectan a los niños. El objetivo de este trabajo es dar a conocer el caso de un niño con migración errática de Ascaris lumbricoides adjunto al testículo, en la túnica vaginalis, secundario a divertículo de Meckel perforado. Caso clínico. Se trató de un paciente masculino escolar con cuadro de abdomen agudo. Se realizó laparotomía exploradora y se encontró divertículo de Meckel perforado con Ascaris lumbricoides libres en cavidad abdominal, y con migración a escroto de áscaris lumbricoides hembra adulto a través de hernia inguinal. Conclusiones. Se discutió acerca de la epidemiología y la presentación clínica del abdomen agudo, de la ascariasis y de los hallazgos transoperatorios.

Background. Ascaridiasis is one of the main parasitosis affecting children. The main objective is to demonstrate the case of a child with erratic migration of Ascaris lumbricoides found next to the testis in the vaginalis tunic secondary to a perforation of Meckel diverticulum. Case report. We present the case of a school-age male patient who was treated at our clinic due to acute abdomen. Laparotomy was carried out, revealing a perforation of Meckel diverticulum with Ascaris lumbricoides free in the abdominal cavity and with migration to scrotum of female adult Ascaris lumbricoides by way of an inguinal hernia. Conclusions. We discuss the epidemiology and clinical presentation ofacute abdomen of Ascaridiasis and intraoperative study.

Torsión testicular perinatal: resultados de 10 años de experiencia / Perinatal testicular torsion: results of 10 years of experience

Introducción: la torsión testicular perinatal es definida como la torsión del testículo en período prenatal, o dentro de los primeros 28 días de vida. Objetivo: evaluar los datos obtenidos de las historias clínicas, y proponer principios de tratamientos clínicos y quirúrgicos. Métodos: fueron revisadas retrospectivamente las historias clínicas de los recién nacidos operados con diagnóstico de torsión testicular en el servicio de cirugía pediátrica del Hospital Pediátrico William Soler, entre enero de 2000 y diciembre de 2009. Resultados: 18 pacientes fueron elegibles para el estudio, 17 tenían torsión unilateral con testículo aumentado de tamaño duro e indoloro (94 por ciento), 55 por ciento tenían hidrocele contralateral, 16 pacientes nacieron a término, con más de 3 100 g de peso (88 por ciento), y la torsión extravaginal y la afectación del testículo izquierdo se observó en 13 (72 por ciento). Un caso fue bilateral asincrónico (6 por ciento), pues el testículo izquierdo estaba torcido en la región inguinal, isquémico, pero no necrótico, y fue preservado. Dos casos (12 por ciento) tenían torsión de tipo intravaginal, y uno de ellos se presentó, clínicamente, como escroto agudo. Se diagnosticó la afección en edades de 0 a 7 días en el 72 por ciento de los casos. Se realizó orquiectomía sin exploración contralateral a 16 pacientes (88 por ciento). La evolución fue satisfactoria en 17 (94 por ciento). Conclusiones: la torsión testicular perinatal representa el 3,4 por ciento de las afecciones quirúrgicas neonatales, y puede afectar un testículo no descendido. Se sugiere protocolizar el uso del ultrasonido doppler preoperatorio, y la exploración y fijación del testículo contralateral

Introduction: the perinatal testicular torsion is defined as a twist of testicle in prenatal period or within the first 28 days of life. Objective: to assess the data obtained from the medical records and to propose the principles of clinical and surgical treatments. Methods: retrospectively the medical records of newborn operated on diagnosed with testicular torsion were reviewed admitted in the pediatric surgery service of the William Soler Teaching Children Hospital from January, 2000 to December, 2009. Results: eighteen patients were eligible for study, 17 had a unilateral torsion with a testicle of increase size, hard and painless (94 percent), the 55 percent had contralateral hydrocele, 16 patients born at term weighing more than 3 100 g (88 percent), the extravaginal torsion and left testicle involvement was observed in 13 (72 percent). A case had bilateral asynchronism (6 percent), since the left testicle was twisted in the inguinal region with ischemia but not necrosis and could be preserved. Two cases (12 percent) had torsion of intravaginal type and one of them was clinically presented as acute scrotum. The affection was diagnosed in ages from 0 to 7 days in the 72 percent of cases. An orchiectomy was performed without contralateral exploration in 16 patients (88 percent). Evolution was satisfactory in 17 cases (94 percent). Conclusions: the perinatal testicular torsion accounts for the 3,4 percent of neonatal surgical affections and may to involve a und-descent testicle. Authors suggest making a protocol of preoperative Doppler ultrasound and the exploration and fixation of contralateral testicle

Escroto Agudo: frecuente urgencia uro-pediátrica / Acute scrotum: frequent urologic- pediatric urgency

Objetivo: analizar los pacientes tratados por escroto agudo en el Hospital Provincial Pediátrico Docente Eliseo Noel Caamaño, de Matanzas. Pacientes y métodos: entre enero del 2000 al 2010, ingresaron 96 pacientes con escroto agudo, de los cuales 54 fueron diagnosticados de torsión testicular, 26 de torsión de hidátide de Morgagni, 13 de orquiepididimitis aguda asociadas a trauma o no, y 3 de edema escrotal. Resultados: la mayor incidencia fue en la primera década de la vida. En el estudio analizado la torsión testicular fue la primera causa, seguida de la torsión de la hidátide. Conclusiones: los pacientes portadores de estas dos causas de escroto agudo deben ser sometidos a tratamiento quirúrgico lo más urgente posible.

Objective: Analyzing the patients treated for acute scrotum at the Teaching Pediatric Provincial Hospital Eliseo Noel Caamaño, of Matanzas. Patients: From January 2000 to 2010, 96 patients entered the hospital with acute scrotum; 54 of them were diagnosed as testicular torsion, 26 as torsion of Morgagni hydatid, 13 as acute orchiepidydimitis associated to trauma or not, and 3 of scrotal edema. Results: The higher incidence was in the first decade of life. In the analyzed study the testicular torsion was the first cause, followed by the hydatid torsion. Conclusions: the patients who have these two causes of acute scrotum should be objects of surgical treatment as urgent as possible.

Compromiso testicular en púrpura de Schõnlein Henoch, utilidad de la ecotomografía doppler / Testicular involvement in Henoch-Schõnlein purpura: the useful of doppler sonography

El púrpura de Schõnlein Henoch (PSH) es la vasculitis más frecuente de la infancia; afecta principalmente la piel, articulaciones y sistema gastrointestinal. El compromiso de los testículos se observa en el 15 por ciento de los pacientes, pero es raro como forma de presentación (1-2 por ciento). El presente caso clínico describe un niño de 4 años de edad sin antecedentes mórbidos que consultó por dolor, eritema, aumento de volumen testicular derecho y púrpura palpable de extremidades inferiores, cuya ecografía testicular mostró testículos normales con flujo Doppler normal y aumento de grosor de escroto y cordón espermático ipsi lateral. Exámenes de laboratorio fueron normales. Se diagnosticó PSH con compromiso testicular y se trató exitosamente con corticoides orales por una semana. Es importante considerar esta patología como diagnóstico diferencial de testículo agudo, para evitar la exploración quirúrgica innecesaria. Las características ecográficas permiten confirmar la sospecha diagnóstica.

Henoch Schõnlein purpura is the most common vasculitis presenting in the childhood, with frequent skin, articular and gastrointestinal compromise. Testicular pain is rare as an onset symptom (1-2 percent), but 15 percent of the cases develop it during the illness course. This case report describes a previously healthy 4 year old boy, who was admitted in theemergency department with a painful, erythematous right scrotal swelling, associated with palpable purpura on both inferior extremities. Testicular Color Doppler US imagingout ruled testicular alterations, but the ipsilateral scrotum and spermatic cord were enlarged. Blood was drawn for serologic and hematologic testing with normal results. Shõnlein Henoch purpura with testicular involvement was diagnosed and successfully treated with oral corticosteroids for one week. It is important to consider Schõnlein Henoch purpura among the differential diagnosis of acute testicle in order to avoid unnecessary surgical exploration. Testicular Doppler Ultrasound imaging is recommended to confirm the diagnosis.

Acute Epididymo-orchitis in Newborn Infant

Acute scrotum in newborn infants is unusual and it is even more unusual with infectious origin. The causes of acute scrotum in newborn infants include hydrocele, testicular torsion, torsion of an appendix testis, epididymo-orchitis, meconium peritonitis, testicular tumor, scrotal hematoma and reducible or incarcerated inguinal hernia. Because of lack of typical symptoms and signs, the correct diagnosis of surgical emergencies such as testicular torsion and incarcerated inguinal hernia are often delayed. Recently, color Doppler ultrasonography and testicular scans are being used for differential diagnosis of acute scrotum, although the latter is often technically unsatisfactory due to small size of the testicles in newborn infants. We report a seven day-old male infant with acute scrotum who was diagnosed as acute epididymo-orchitis by color Doppler ultrasonography, and saved from unnecessary surgical interventions. Although color Doppler ultrasonography can not give diagnostic clue for acute scrotum, it can reduce the need for explorative surgery.

Clinical Analysis of Scrotal Involvement in Childhood Henoch-Schonlein Purpura / 소아과

PURPOSE: Henoch-Schonlein purpura(HSP) is a systemic vasculitis affecting predominantly skin, the gastrointestinal tract, the joints and kidneys. Because the scrotal manifestations including swelling and pain (or tenderness) are known to be uncommon in male HSP patients, there has been a little mention of them in the studies of HSP. Therefore, we investigated the clinical and laboratory features of HSP children with scrotal involvement. METHODS: We retrospectively reviewed the clinical and laboratory data of 115 male patients with HSP who had visited Chungbuk National University Hospital in the last 12 years. We evaluated the risk factors for scrotal involvement, and the relation between scrotal involvement and other clinical features, including renal manifestations in HSP. RESULTS: The incidence of scrotal involvement was 21.7%(25/115). Scrotal symptoms manifested as swelling in 88.0% and pain(or tenderness) in 68.0% of HSP patients with scrotal involvement. Of various manifestations, neurologic symptoms and localized edema were more frequent in the scrotal- involved group compared with non-involved group. Of immunologic indices, serum C3 level of scrotal involvement group was significantly higher than that of the other. However, there was no difference in the improvement of scrotal symptoms according to therapy, and scrotal involvement had no correlation with renal involvement during the acute to chronic phases. CONCLUSION: We found that neurologic symptoms, localized edema and high serum C3 level show a significant relation with scrotal involvement in male HSP patients. Because scrotal involvement in male HSP patients is not rare, about 21.7%, pediatricians and urologists should search for the presence of purpura in childhood acute scrotum.

Experiences of 313 Cases of Acute Scrotum: Properties of Acute Epididymitis and Differential Diagnosis of Testicular Torsion / 대한비뇨기과학회지

PURPOSE: An acute scrotum is a pathologic condition of the scrotum or intrascrotal contents that require emergency medical or surgical treatment. Because proper treatment and the outcomes are very important in reproduction, the records of patients who had acute scrotal diseases were reviewed for early and proper diagnosis and treatment. MATERIALS AND METHODS: The medical records of 313 patients with acute scrotal pain and swelling were retrospectively reviewed. The final diagnoses were made from the symptoms, a physical examination, the laboratory tests, a color Doppler ultrasound (US), and the surgical findings in cases that underwent surgery. Age, the presence of a urinary tract infection, an underlying disease, seasonal distributions, laterality and the accuracy of color Doppler US in acute epididymitis and testicular torsion were all analyzed. The missed cases of testicular torsion were also reviewed carefully. RESULTS: The most common disease of an acute scrotum was acute epididymitis in both adults and children. Urinary tract infections were not common in children with acute epididymitis. Testicular torsion occurred commonly in the left side, while acute epididymitis developed in same distributions. The mean age of an acute scrotum were 24.1 years; a testicular torsion was 16.0 years and an acute epididymitis was 25.4 years. The color Doppler US demonstrated a 82.5% sensitivity, a 100% specificity, a 100% positive predictive value and a 97.5% negative predictive value for testicular torsion. CONCLUSIONS: Acute epididymitis is also common in children. Although color Doppler US is useful in a differential diagnosis of an acute scrotum, a careful physical examination and follow up of the patient status are important to reduce the incidence of a misdiagnosis.

Clinical Features of Acute Scrotum in Children

PURPOSE: The acute scrotum is a clinical syndrome that is defined as an acute, painful swelling of the scrotum or its contents. The symptoms and signs of acute scrotum are similar and its pathognomonic features are rarely detected. This study was performed to find a proper way to diagnose and treat acute scrotum promptly and correctly. METHODS: From January 1990 through December 1999, 31 cases of pediatric patients hospitalized in this center with acute scrotum were analyzed for diagnosis, seasonal incidence, age distribution, time interval from the onset of symptoms to admission, symptoms and signs, laboratory and radiologic findings and therapeutic details. RESULTS: Acute scrotum included 13 cases of testicular torsion(41.9%), 9 cases of acute epididymitis(29.0%), five cases of torsion of appendages (16.1%), and four cases of orchitis(12.9%). Twelve cases(38.7%) were observed from March to May. The average time interval from the onset of symptoms to admission was 11.6 hours and 46.1 hours for testicular torsion and acute epididymitis, respectively. All testicular torsion showed no cremasteric reflexes. Only three out of 13 cases of testicular torsion were successfully treated with manual detorsion. Seven cases underwent testis reduction and orchiopexy. The remaining three cases of testicular torsion showing the necrosis of testes were treated with orchiectomy. CONCLUSION: Color doppler ultrasonography, testicular scintigraphy, and physical examination such as cremasteric reflex are useful for diagnosis. Surgical procedures can be the most effective treatment for testicular torsion, and the antibiotic treatments for both epididymitis and orchitis. However, conservative treatment can be effective in the case of torsion of appendages.

Escroto agudo / Acute scrotum

Este artigo pretende fazer uma revisão geral do tema, com ênfase em conceitos atuais e/ou controversos no manejo das situações clínicas em questão, em especial conceitos ainda polêmicos quanto à fisiopatologia e ao manejo diagnóstico. Também é feita uma revisão extensa quanto aos aspectos clínicos e terapêuticos da torção de testículo neonatal e quanto aos aspectos de diagnóstico diferencial na síndrome do escroto agudo. São citadas informações estatísticas derivadas dos principais estudos clínicos publicados nos últimos 20 anos em literatura médica ocidental.

This article intends to review "Acute Scrotum" emphasizing modern and controversial aspects on clinical situations, specially concepts on physiopathology and diagnosis. We also review clinical and therapeutic aspects of neonatal testicular torsion and the differential diagnosis in the acute scrotum syndrome. Statistical information are derived from main studies published in the last 20 years.

Acute scrotum in 7 cases of Schoenlein-Henoch syndrome

Schoenlein-Henoch syndrome (SHS), one of the manifestations of systemic vasculitis, usually involves the skin, gastrointestinal tract, joints and kidney. Since the involvement of male genitalia is very rare and there is little mention of it in textbooks, doctors have a tendency to neglect this finding in SHS. Unless there is a confirming diagnosis, it is easily mistaken for testicular torsion and the patients undergo unnecessary operations because they complain of unbearable scrotal pain. SHS is not uncommon in Korea, but hardly any cases of scrotal involvement are found. We have experienced 7 cases of acute scrotum associated with SHS admitted to Severance Hospital, Yonsei University College of Medicine during the last 20 years; 2 underwent operation and 5 received conservative treatment only.

Evaluation of the Acute Scrotum by Color Doppler Ultrasonography and Radioisotope Imaging in Children / 대한비뇨기과학회지

Acute scrotum is defined as an acute painful swelling of the scrotum or its content. There are many conditions it may cause acute scrotum, but since a delay in the diagnosis and treatment may led to necrosis and its loss, the possibility of torsion of the spermatic cord should be ruled out in the first place. In a retrospective study of 32 childhood patients with acute scrotum presenting to Chungbuk National University Hospital from March 1992 to March 1995, we evaluated general aspects of acute scrotum including the result of follow up. The incidence of acute epididymitis, testicular torsion, mumps orchitis, and torsion of a testicular appendage were 66%, 19%, 9% and 6%, respectively. Of the eight scrotal explorations performed, 6 had testicular torsion, and 2 had torsion of appendages. With the exception of cases of far advanced necrotic testes, both color Doppler ultrasound and radioisotope imaging were highly specific diagnostic modalities. But, because of the potentially devastating outcome of a false-negative result of imaging studies, we continue to believe that physical exam is the best guide regarding the necessity of surgical exploration and all patients with unequivocal examinations are best served by prompt surgical therapy.

The Clinical Significance of Torsion of Appendix Testis in Acute Scrotum / 대한비뇨기과학회지

The torsion of appendix testis is the second most common disease of the acute scrotal diseases in frequency. Despite recent development of diagnostic equipments, its differential diagnosis is often difficult and its treatment is controversial. We reviewed retrospectively 19 cases who were diagnosed to have torsion of appendix testis during recent 6 years. The mean age was 11.3 years. Five cases who had blue dot sign and tender mass on upper pole of testis, and one of 9 who had been examined with scrotal ultrasonography were diagnosed to have torsion of appendix testis, but other clinical finding and laboratory findings were not contributable to its diagnosis. Nine of 14 cases who were diagnosed by surgical exploration were consistent with the preoperative impression. Mean duration of scrotal pain were 1.3 days in surgical treatment group and were 3.6 days in conservative treatment group. The pathognomonic sign of torsion of appendix testis was seen only in a few cases. The diagnostic accuracy of torsion of appendix testis before exploration was low. The scrotal pain was relieved relatively more rapidly in surgical treatment group. So, we think that surgery was more desirable in diagnosis and treatment of torsion of appendix testis.

Value or Color Doppler Ultrasonography in Acute Scrotum / 대한비뇨기과학회지

Color doppler ultrasonography is a combination of real-time sonography and doppler sonography for imaging of arterial and venous blood vessels. There is an increased use of scrotal ultrasonography in the clinician's office and emergency room for the investigation of acute scrotum. From March 1992 to Apri1 1994, 61 patients with acute onset of scrotal pain were managed. Eleven of them were testicular torsion, 37 were inflammatory conditions, and one case was appendiceal torsion by color doppler ultrasonography. One of 11 patients with testis torsion was misdiagnosed by color doppler ultrasonography. This patient proved acute epididymitis by exploration. Among the 37 patients who were diagnosed inflammatory condition by color doppler ultrasonography two patients were testis torsion by scrotal exploration. Sensitivity of testicular torsion was 83% and specificity was 91% by color doppler ultrasonography. Color doppler ultrasonography readily demonstrates testicular blood flow and it is the most valuable diagnostic modality in evaluation of the acute scrotum.