Etiology of acute scrotal pain in children and adolescent patients admitted in Ahvaz Educational Hospitals
Purpose Acute scrotum is an emergency condition requiring rapid intervention. The aim of this study was to evaluate the clinical and epidemiological specifications of acute scrotum.
Patients and methods This retrospective study was carried out on patients less than 21 years admitted with a diagnosis of acute scrotum in the surgical and medical wards from 2009 to 2010. One hundred and thirty-nine patients were included in this study. Epi-info version 6.4 (CDC) was used for data analysis.
Results The final diagnoses were as follows: spermatic cord torsion (n =57, 41.00%), incarcerated inguinal hernia (n =30, 21.60%), epididymo-orchitis (n= 28, 20.14%), missed torsion (n =15, 10.79%), testicular trauma (n=5, 3.60%), and torsion of the appendix of the testis (n= 4, 2.87%). The most common age groups in relation to the diagnoses were as follows: testicular torsion and missed torsion (10–15 years, 34.7%), torsion of appendix testis (10–15 years, 100%), epididymo-orchitis (15–21 years, 85.71%), and incarcerated inguinal hernia with two peaks of age ( <5 years, 46.7%). Fifty-eight patients (41.72%) visited the hospital less than 6 h after the onset of pain. Twenty-eight patients underwent orchiectomy or orchiopexy and 38 patients underwent detorsion and bilateral orchiopexy. A herniotomy was performed in 15 patients and herniorraphy in 10 patients. An appendectomy was performed in four patients. Other procedures were carried out in seven patients. Out of 72 patients diagnosed with torsion (57 patients) or missed torsion (15 patients), 38 patients (52.7%) underwent a testicular salvage surgery (detorsion and orchiopexy). Out of all patients (139 patients), 92 patients underwent surgery and the rest (47 patients) were treated conservatively. These 47 patients had epididymo-orchitis (n= 28), testicular trauma (n =4), incarcerated inguinal hernia (n= 5), and missed torsion and testicular torsion (n= 10). Out of 27 patients with abnormal urinary findings, 19 patients had epididymo-orchitis.
Conclusion The most common important differential diagnosis for acute scrotum is spermatic cord torsion. Most of the abnormal urinary findings were observed in patients with epididymo-orchitis. Most of the patients underwent surgery less than 6 h of disease onset. In patients with spermatic cord torsion, the affected testis has to be evaluated and treated during the first 6 h of presentation.
Keywords: epididymitis, epididymo-orchitis, herniotomy, hydrocele, inguinal hernia, orchiopexy, scrotum, testicular torsion, trauma