Surgical Aspect of acute scrotum of children (a prospective study)
NABIL YOUSEF ABOU EL DAHAB, E.A. Abdelbary,
Surgery Department, Sohag Faculty of medicine, Sohag University
Abstract
Background:
Acute painful swelling of scrotum is common surgical emergency and it requires hospital admission. Although most aetiologies of acute scrotal swelling are not emergent, some atypical presentations of testicular torsion , delayed recognition of the condition and its confusion with other causes of acute scrotum can delay diagnosis and may lead to testicular necrosis and orchidectomy . Colour Doppler scanning can play important role in differentiation in these doubtful cases.
Aim of the work:
To review clinical presentations, diagnosis, and management of common causes of acute scrotum in children in Sohag and highlight role of colored Doppler scanning in the management.
Material and methods:
60 children diagnosed as acute scrotum were admitted at surgery department of Sohag university hospital from April 2000 to April 2005. The age ranged from two years to 14 years. Cases of obstructed inguinal hernia and testicular tumour are excluded from the study. Patients are classified into four main groups: epididymoorchitis (1), torsion of testicular appendage (2), torsion of testis (3), and idiopathic scrotal oedema (4). A comparative study was done between four groups as regard to mean age, history of trauma, duration of symptoms, affected site of pathology and local signs. These data were analyzed using chi square test and statistical significant results were recorded. Also, recording degree of accuracy and percentage of successful rate of coloured Doppler scanning in the diagnosis.
Results: Group (1) was 26 cases [43.3%], Group (2) was 21 cases [35%], Group (3) was 8 cases [13.3%] and Group (4) was 5 cases [8.3%]. Mean age was 8.4 in groups 1, 10.6 in group 2, 5.6 in group 3 and 6 year in group 4. History of trauma was11.5% in group 1, 50% in group 2, 87.5% in group 3 and 20% in group 4. The lesion was bilateral in 15% of g. 1, 34% of g. 2, 12.5% of g. 3 and in all cases of g. 4. 39 patients were diagnosed by history and clinical examination confirmed by scrotal ultrasound. 21 patients were diagnosed by coloured Doppler scanning. (10 cases were epididymoorchitis, 7 cases were torsion of testicular appendix and 4 cases were torsion of the spermatic cord) with successful rate 85% and Specificity test 97 %. 31patients (51.7%) were subjected to conservative medical treatment, Exploration was done in 29 patients (48.3%), orchiopexy was done in 26 patients and orchidectomy was done in 3 patients. Testicular salvage rate was 89.5%.
Conclusion:
History and clinical examination are considered enough data for diagnosis and management of cases of acute scrotum in children. An absent Cremasteric reflex was the most sensitive physical finding for diagnosing torsion of the testes. Scrotal ultrasound could confirm our diagnosis in patients with scrotal oedema and early epididymoorchitis. When physical findings are equivocal, or the ultrasound findings are inconclusive, colored Doppler scanning is mandatory.
Key words: torsion of the testis, torsion of the testicular appendix, acute epididymoorchitis, idiopathic scrotal oedema, congenital anomalies in children.