Management of acute scrotum in children—the impact of Doppler ultrasound

Abstract

Background Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken. Method Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scrotal DUS, and standard laboratory analysis. Depending on scrotal DUS findings, the children were treated either nonoperatively (normal or increased testicular blood flow) or surgically (reduced or absent testicular blood flow). A follow-up investigation 6 weeks after discharge included a scrotal DUS. Results In 66 children (84%), the result of DUS determined the management; 26 children with hyperperfusion (epididymitis and orchitis), 18 children with appendix testis torsion (ATT), and 9 children with normal perfusion (edema and hematoma) were treated nonoperatively. The follow-up examination revealed no testicular atrophy and confirmed the primary diagnosis. Ten children without testicular perfusion and suspected torsion and 3 children with orchitis and pyocele were surgically explored, and again, the initial DUS diagnosis was verified. In the remaining 13 patients (16%), the result of the ultrasound examination was unclear. Of these, 6 children were noncompliant and refused to undergo ultrasonography. Another 4 children were explored because of persistence of symptoms. In 3 additional patients, a testicular tumor was suspected. All these 13 children underwent surgical exploration, revealing inflammation (epididymitis) in 6 children and acute ATT in 4 children, whereas the suspected tumor emerged as postacute ATT in 3 boys. Conclusion In 84% of children with acute scrotal pain, the DUS was able to differentiate between surgical emergencies and other etiologies. In 16% of our pediatric patients, the DUS remained unclear, thereby necessitating surgical exploration.