Outcomes of routine surgical exploration in children who admitted to the emergency service with acute scrotum

Yıl 2017, Cilt: 3 Sayı: 2, 152 - 156, 04.07.2017

Serpil Sancar , Esra Ozcakir , Mete Kaya

https://doi.org/10.18621/eurj.269349

Öz

Objectives. The acute scrotum
frequently presents a diagnostic and therapeutic challenge. In cases where the testicular
torsion cannot be excluded, a surgical exploration is recommended. The aim of
the study was to present the results of our management in the patients with acute
scrotum. Methods. We reviewed the medical records of 33 patients
suffering from acute scrotal pain underwent scrotal exploration between 2011
and 2016. Anamnestic data (age of patient, duration of anamnesis prior to
admission and the side that was involved), scrotal color Doppler ultrasound
(SCDUS) results, intraoperative findings, mode of operative treatment, and the
clinical outcomes were analyzed. Results. Patients aged from several
hours up to 17 years of age (average 11.9 years). The duration of symptoms
prior to admission ranged from 3 h to 4 days, (average 32 h). Acute scrotum was
found 18 in right side, 15 in left side. SCDUS was diagnostic for testicular
pathologies in 19 (51%) of 30 patients. In patients who underwent scrotal
exploration, 18 (54%) had a testicular torsion, 11 (33%) had a torsion of the appendix
testis, and 4 (12%) had an orchio-epididymitis. Three patients who found testicular
torsion required an orchidectomy immediately because of necrosis. The rest had
detorsion and ipsilateral fixation of testis. Three patients underwent second
look, and orchiectomy was performed in 2 of them. In 2 of detorsioned testes,
two testicular atrophies developed on follow-up period. Conclusion. Regardless of
the etiology, the management of the patients with acute scrotum by urgent
surgical intervention allows the salvage of a possible testicular torsion. 

Anahtar Kelimeler

Acute scrotal pain, testicular torsion, torsion of appendix testis, orchio-epididymitis

Kaynakça

• [1] Vasdev N, Chadwick D, Thomas D. The acute pediatric scrotum: presentation, differential diagnosis and management. Curr Urol 2012;6:57-61.
• [2] Altinkilic B, Pilatz A, Weidner W. Detection of normal intratesticular perfusion using color coded duplex sonography obviates need for scrotal exploration in patients with suspected testicular torsion. J Urol 2013;189:1853-8.
• [3] Makela E, Lahdes-Vasama T, Rajakorpi H, Wikstrom S. A 19-year review of paediatric patients with acute scrotum. Scand J Surg 2007;96:62-6.
• [4] Pogorelic Z, Mrklic I, Juric I. Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males. J Pediatr Urol 2013;9:1161-5.
• [5] Tajchner L, Larkin JO, Bourke MG, Waldron R, Barry K, Eustace PW. Management of the acute scrotum in a district general hospital: 10-year experience. Scientific World J 2009;9:281-6.
• [6] Yu Y, Zhang F, An Q, Wang L, Li C, Xu Z. Scrotal exploration for testicular torsion and testicular appendage torsion: emergency and reality. Iran J Pediatr 2015;25:e248.
• [7] Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int 2013;112:1201-6.
• [8] Bayne AP, Madden-Fuentes RJ, Jones EA, Cisek LJ, Gonzales ET Jr, Reavis KM, et al. Factors associated with delayed treatment of acute testicular torsion - do demographics or interhospital transfer matter? J Urol 2010;184:1743-7.