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KMID : 1218220090010020100
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Korean Journal of Pediatric Urology
2009 Volume.1 No. 2 p.100 ~ p.104
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Clinical Outcomes of Scrotal Exploration for Acute Scrotum in Children Less Than 13 Years Old
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Kim Hyun-Seung
Lee Seung-Wook
Yoo Tag-Keun
Kang Jeong-Yoon
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Abstract
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Purpose: Acute scrotum is a medical and surgical emergency condition of the scrotum. If testicular torsion, in which early surgical intervention is needed, is not ruled out, scrotal exploration is commonly required. We assessed clinical outcomes of children less than 13 years old who underwent scrotal exploration for acute scrotum.
Patients and Methods: We retrospectively reviewed the medical charts of 57 children less than 13 years old who underwent scrotal exploration for acute scrotum between January 2000 and May 2009. Careful history, duration of scrotal pain, physical examination results, laboratory findings, doppler ultrasonographic findings were reviewed. We compared preoperative presumptive diagnoses with postoperative confirmed diagnoses.
Results: The mean age of the children was 8.5±3.0 years. Forty-three children (75.4%) were admitted through the emergency department, and 14 children (24.6%) visited the outpatient clinic. Of the 53 children, 16 (28.1%) visited our hospital within 6-8 hours of the onset of scrotal pain. Pyuria was detected in 2 children (3.5%), and leucocytosis in 12 children (21.1%). Blue dot sign was present only in 3 children. Scrotal color doppler ultrasonography was performed on 19 children (33.3%). On preoperative evaluation, testicular torsion was suspected in 5 children (8.8%), torsion of the testicular appendage in 19 children (33.3%), acute epididymitis in 12 children (21.1%) and none determined in 21 children (36.8%). By preoperative color doppler ultrasonography, which was performed on 19 children, testicular torsion was detected in 3 children (15.8%), torsion of the testicular appendage in 4 children (21.1%) and epididymitis in 12 children (63.1%). In 19 children undergoing ultrasonography, the final diagnosis established after scrotal exploration was testicular torsion (n=3), torsion of the testicular appendage (n=14) or epididymitis (n=2). Overall, the final diagnosis after scrotal exploration was testicular torsion in 12 children (19.0%), torsion of the testicular appendage in 48 children (76.2%) and epididymitis in 3 children (4.8%).
Conclusions: Although doppler ultrasonography has a high accuracy in diagnosis of testicualr torsion, it is not highly accurate for differentiation between torsion of the testicular appendage and epididymitis.
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KEYWORD
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Acute scrotum, Torsion, Testicular appendage, Epididymitis
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