Torsion Of Appendages Research Articles

CLINICAL STUDY OF ACUTE SCROTUM

We reviewed 37 cases of acute scrotum experienced in Tone Chuo Hospital between June 1 1987 and December 31, 1994. The final diagnoses in 37 were trauma in 6, tumor in 3, acute epididymitis in 21, torsion of testicular cord in 4, torsion of appendage in 2 and acute orchitis in 1. Patient mean age were 41.4 in trauma, 30.0 in tumor, 43.8 in acute epididymitis, 10.5 intorsion of testicular cord, 8.0 in torsion of appendage and 27 in acute orchitis. The interval between onset and hospital visit were 5.8 hours in trauma, 84 hours in tumor, 72.6 hours in acute epididymitis, 7.25 hours in torsion of testicular cord, 42 hours in torsion of appendage and 24 hours in acute orchitis. The testes in 4 cases torted intravaginally and had anatomical abnormality of testis fixation. We performed orchiopexy for the affected sides and other sides, which also had an abnormality of testis fixation. We were able to preserve all testes except for 3 cases of tumor.

Etiology of acute scrotum at surgical exploration in children, adolescents and adults.

Between January 1970 and December 1989, 171 patients underwent scrotal exploration for acute scrotum (an acute painful swelling of the scrotum or its content), at our hospital. Of 70 children scrotal explorations, torsion of appendages was found in 33 cases (47%). Torsion of testis was found in 24 patients (34%). Of the 84 adolescent scrotal explorations performed, 72 (86%) had torsion of testis, and 8 (9%) had torsion of appendages. Of 17 adults, torsion of testis was found in 15 cases (88%). These results clarify that unnecessary explorations are much more common in children (66%) than in adolescents and adults (14%). We therefore suggest using radionuclear scans and/or Doppler ultrasound to facilitate clinical diagnosis in the children group.

The acute scrotum in childhood

A review was made of 771 children with an acutely inflamed scrotum presenting during the 10 years 1976–1985. The relative incidence and age distribution of testicular torsion, torsion of an appendage, and epididymitis was compared. Epididymitis (13%) had a peak incidence in the first 2 years of life when urinary tract infections were common. The incidence of epididymitis was significantly lower than previously, and may reflect a changing pattern of disease. In addition, some patients with a diagnosis of epididymitis may have had infarction of a testicular appendage without haemorrhage. Torsion of a testicular appendage (58%) was most frequent at 11 years of age, 2 years before the maximum incidence of torsion of the testis (29%) at 13 years. This difference in timing may reflect a response by the cranial remnant of the mullerian duct to an increase in circulating oestrogens at the onset of puberty.