Retrospective review of pediatric patients with acute scrotum

Abstract

The authors sought to investigate the reliability of history and clinical examination in the diagnosis of an acute scrotum. Of 268 boys that presented to a tertiary pediatric institution in Sydney between January 1994 and December 1998, 58 were excluded as a result of previous testicular fixation, intrauterine torsion, uncertain diagnosis, or incomplete medical records. Mean age of the remaining 204 boys was 9 years (range, 1 month to 15.5 years). One hundred ten had torsion of a testicular appendage, 40 testicular torsion, and 29 epididymo-orchitis. The only significant difference in clinical features between the 3 groups was in the duration of symptoms: boys with testicular torsion presented significantly earlier (P < .005; median, 9.5 hours v 48 hours). Surgical exploration was performed in 187 boys. History and physical examination together provided the correct diagnosis in 87.5% of boys with testicular torsion, 83% with torsion of an appendage, and 56% with epididymo-orchitis. Retrospective data collection and the variable seniority of the surgeon performing the initial assessment compromised this study. The proposal that a history of greater than 24 hours might be used as a suitable cut-off point for surgical exploration assumes that all torted testes remain torted. Further, the authors own data identified 2 patients with viable testes despite having symptoms for greater than 24 hours. Although routine exploration would not seem appropriate for all patients, for those in whom the diagnosis remains uncertain, exploration remains the safest course.—A.J.A. Holland The authors sought to investigate the reliability of history and clinical examination in the diagnosis of an acute scrotum. Of 268 boys that presented to a tertiary pediatric institution in Sydney between January 1994 and December 1998, 58 were excluded as a result of previous testicular fixation, intrauterine torsion, uncertain diagnosis, or incomplete medical records. Mean age of the remaining 204 boys was 9 years (range, 1 month to 15.5 years). One hundred ten had torsion of a testicular appendage, 40 testicular torsion, and 29 epididymo-orchitis. The only significant difference in clinical features between the 3 groups was in the duration of symptoms: boys with testicular torsion presented significantly earlier (P < .005; median, 9.5 hours v 48 hours). Surgical exploration was performed in 187 boys. History and physical examination together provided the correct diagnosis in 87.5% of boys with testicular torsion, 83% with torsion of an appendage, and 56% with epididymo-orchitis. Retrospective data collection and the variable seniority of the surgeon performing the initial assessment compromised this study. The proposal that a history of greater than 24 hours might be used as a suitable cut-off point for surgical exploration assumes that all torted testes remain torted. Further, the authors own data identified 2 patients with viable testes despite having symptoms for greater than 24 hours. Although routine exploration would not seem appropriate for all patients, for those in whom the diagnosis remains uncertain, exploration remains the safest course.—A.J.A. Holland