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Testicular scanning with 99mtechnetium pertechnetate is a well established, useful and readily available technique for the rapid assessment of patients with scrotal pain. Its use allows accurate differentiation of testicular torsion from other entities, such as epididymo-orchitis and, thus, obviates scrotal exploration in a large number of cases. We herein report our experience with 72 cases. Only 1 falsely positive scan was obtained in 15 patients thought to have torsion, this being secondary to an incarcerated hernia extending into the scrotum. Of the remaining 14 patients undergoing scrotal explorations for testicular torsion the scan was accurate in 100 per cent of the cases.
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PMID:Testicular scanning: clinical experience with 72 patients. 720 81

Epididymo-orchitis (EO) is said to be extremely rare in infants and children. It is usually diagnosed after scrotal exploration for symptoms which mimic manifestations between EO and torsion of the cord and its appendage. The pathophysiologic mechanisms for the development of EO are not well known. Although some causative agents of EO have been reported, in most cases there was no clear etiology. We report a 3-month-old male infant who had been well until the day prior to admission when irritability, left testicular swelling, scrotal erythema with a hot sensation were noted by his mother. He was treated medically after excluding the possibility of an emergent surgical condition (such as torsion of the cord and its appendage, or incarcerated hernia) by means of physical examinations, abdominal and inguino-scrotal sonography, laboratory studies, and testicular radionuclide scintigraphy. A catheterized sample of urine for culture yielded Escherichia coli. There was the possibility that the EO was caused by hematogenous rather than local spread from an infection of the urinary tract. He was treated with a 10-day course of intravenous cefazolin and amikacin. Following this, he improved clinically and a repeat catheterized urine sample remained sterile on culture. In addition, a bilateral inguinal hernia and hydrocele were detected by inguino-scrotal sonography and were operated on the 11th hospital day. He was discharged on the 16th day of hospitalization and remained well 11 months after discharge.
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PMID:Epididymo-orchitis in an infant resulting from Escherichia coli urinary tract infection. 893 11

Primary care physicians, including family practitioners and pediatricians, frequently are consulted about children and adolescents with disorders of the inguinal canal and scrotum and are asked about the proper course of management, even if only to confirm an opinion of the surgical specialist. The purpose of this communication is to review the management of these conditions, including undescended testis, hydrocele and hernia, varicocele, testicular torsion, testicular trauma, epididymo-orchitis and scrotal edema.
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PMID:Management of common disorders of the inguinal canal and scrotum in childhood and adolescence. 1221 36

The true incidence of the various causes of acute scrotum in children is unclear; epididymo-orchitis (EO) is thought to be uncommon. Investigation for underlying urological abnormality in children with EO is recommended. To determine the incidence of the various pathologies in boys presenting to the emergency department with an acute scrotal condition and assess the value of further investigation of the urinary tract in a subgroup of boys with EO, a retrospective review of 100 consecutive patients admitted with a diagnosis of testicular pain was performed. Seventy had torsion of an appendix testis (TAT) and 12 had torsion of the testicle (TT). Ten boys were admitted with 11 episodes of EO; 7 had other pathologies including incarcerated hernia, varicocoele, and idiopathic scrotal oedema. The diagnosis of EO was made at operation in all 11 episodes. Escherichia coli was cultured in 4 patients; none were found to have underlying urinary tract abnormality. TAT was thus commonest causes of the acute scrotum. EO is not rare in infants, the incidence in this study being equal to the of TT. Subsequent urological investigation did not disclose any underlying abnormality. However, based on the current published literature futher investigation is recommended in selected cases.
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PMID:The incidence and investigation of acute scrotal problems in children. 1241 74

One hundred and seventy-eight patients presenting with an acute scrotum during a period of 18 years (1978-1997) were reviewed retrospectively. Fifty per cent had testicular torsion, with a mean age of 23 years (range 3 weeks-55 years). Torsion was significantly more common in the cold harmattan season (October-early March). The salvage rate of torted testes was 52%. Inguinoscrotal hernia was the cause of testicular infarction in 10% and is an important contributor to male infertility. Twelve per cent of cases of suspected torsion were found to have epididymo-orchitis, at exploration. Twenty-three (13%) patients presented with scrotal gangrene (Fournier's gangrene) which did not result in testicular loss. There was significant morbidity following intervention by non-doctors, and misdiagnosis from unsuspecting physicians. The acute scrotum affecting young patients is a significant cause of male infertility and morbidity in Zaria. Early recognition, prompt treatment and re-education of those who may provide the first line care for such patients will reduce the morbidity and pathologic consequences following neglect.
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PMID:Acute scrotum in Nigeria: an 18-year review. 1495 74

Scrotal swelling may be due to extratesticular and intratesticular lesions. The majority of extratesticular lesions are benign while the majority of intratesticular lesions are malignant. Ultrasonography (US) is helpful in separating extra- from intratesticular lesions. US can show whether a mass is cystic, solid or complex, and also features such as associated calcifications, epididymal involvement, scrotal skin thickening and colour Doppler flow pattern. Extratesticular lesions include hydrocoele, spermatocoele, varicocoele, epididymal cyst, hernia and tumours of the epididymis and cord structures. Intratesticular lesions include primary tumour, metastases, lymphoma and leukaemia. Tuberculous epididymitis or epididymo-orchitis may also present with painless scrotal swelling. US features of these disease patterns, with pathological correlation, are presented in this pictorial essay.
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PMID:Painless scrotal swelling: ultrasonographical features with pathological correlation. 1580 Jul 28

Ultrasonography (US) is well suited to the study of pathologic conditions of the scrotum in children. US provides excellent anatomic detail; when color Doppler and power Doppler imaging are added, testicular perfusion can be assessed. Gray-scale, color Doppler, and power Doppler US were used to study a spectrum of scrotal disorders in 750 boys aged 1 day to 17 years. The entities studied included processus vaginalis-related disorders (cryptorchidism, inguinal-scrotal hernia, and hydrocele); varicocele; acute scrotum (epididymo-orchitis, torsion of the testicular appendages, and testicular torsion); scrotal tumors; testicular microlithiasis; scrotal trauma; and systemic diseases with scrotal involvement. When combined with the results of clinical and physical examination, the information obtained with US is sufficient to enable diagnosis in most cases of scrotal disease. Moreover, color Doppler imaging is essential for differentiation between processes such as epididymo-orchitis or torsion of the testicular appendages and testicular torsion, which have similar clinical manifestations (pain, swelling, and redness) but are managed differently.
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PMID:Gray-scale and color Doppler sonography of scrotal disorders in children: an update. 1616 Jan 6

Inguinal and scrotal suppuration following appendectomy is a rare event, occurring mostly when a patent processus vaginalis is present. Herein we report a small series of children operated for appendicitis and presented with acute inguinal and scrotal symptoms postoperatively. Although acute scrotum is commonly attributed to torsion of testis or its appendage, epididymo-orchitis and incarcerated hernia, following appendicitis scrotal and/or inguinal abscess should be considered.
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PMID:An exceptional complication following appendectomy: acute inguinal and scrotal suppuration. 1716 Apr 51

Paediatric surgeons and urologists are often asked to evaluate boys with acute scrotal pain and inflammation. Although, there is much aetiology for this syndrome: testicular torsion, appendicular testicular torsion, epididymo-orchitis, hernia, hydrocele, trauma, Henoch-Schonlein purpura, idiopathic scrotal edema. However, testicular torsion should be at the top of the list because of the medico legal aspects. It is the one diagnosis that must be made accurately and rapidly, if there is any hope for testicular salvage. Color Doppler ultrasound scan can reliably identify those children, who required exploration and spare medical causes. The purpose of this article is to update/review the appropriate evaluation and management of the acute scrotum and to guide the clinician in distinguishing testicular torsion from the other conditions that commonly mimic this surgical emergency.
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PMID:[Ultrasonography of acute scrotum in children]. 1926 55

Extratesticular lesions are common incidental findings at ultrasonography (US) among men and boys. Most lesions originate from or depend on the tunica vaginalis, a mesothelium-lined sac with a visceral layer and a parietal layer. The tunica vaginalis is formed when the superior portion of the processus vaginalis closes during embryologic development. Abnormal closure of the processus vaginalis leads to congenital anomalies of the tunica vaginalis, such as complete or partial patency of the processus vaginalis, spermatic cord hydrocele, and inguinoscrotal hernia. The proximity of the visceral layer to the testis explains the reactive involvement seen in epididymo-orchitis, with resultant pyocele or abscess formation. The tunica vaginalis also may be affected by inflammatory and traumatic disorders such as scrotal calculi, fibrous pseudotumor, or hematocele. These lesions manifest as solid or heterogeneous tumorlike masses. Lesions of mesothelial origin, such as adenomatoid tumor, tunica cyst, and mesothelioma, may involve the tunica vaginalis. Entrapped mesenchymal cells can lead to lipoma, leiomyoma, or sarcoma, although these tumors are uncommon in the tunica vaginalis. US is not useful for differentiating between benign and malignant tumors; however, some characteristic findings may help in planning the best surgical approach. Knowledge of the embryologic development, anatomic relationships, and pathologic disorders of the tunica vaginalis is essential to narrow the differential diagnosis of an extratesticular lesion. In most cases, US findings in combination with clinical assessment can indicate whether nonsurgical management or testis-sparing surgery is warranted.
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PMID:US of the tunica vaginalis testis: anatomic relationships and pathologic conditions. 1992 60


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