Chapter 3 ACUTE SCROTUM Theodore X. O’Connell General Discussion Every male patient with the acute onset of pain and swelling of the scrotum requires an immediate evaluation to diagnose or exclude testicular torsion. Of the cases of acute painful scrotum, 30% are caused by testicular torsion. Testicular torsion represents a true surgical emergency because the likelihood of testicular salvage decreases as the duration of torsion increases. The rate of testicular salvage is highest with symptoms 6 or fewer hours in duration. In children in whom the duration of symptoms is short and in whom clinical history and physical examination strongly suggest the diagnosis of acute testicular torsion, imaging studies may be bypassed in favor of surgical exploration. The age of the child may help guide the evaluation. Testicular torsion may occur at any age but is more common during the newborn period and during early puberty. Appendiceal torsion and Henoch-Schönlein purpura are more common in prepubertal boys. Epididymitis is more common in adolescents and young adults. The abrupt onset of severe pain is characteristic of testicular torsion. Mild to moderate pain that develops over several days is more suggestive of epididymitis or appendiceal torsion. An acute scrotal process may be referred to the abdomen, so any child presenting with an acute abdomen must have a complete genital examination. Causes of Acute Scrotal Pain Acute idiopathic scrotal edema Allergic reaction Appendiceal torsion Epididymitis Henoch-Schönlein purpura Hydrocele Inguinal hernia Insect bite Orchitis Testicular torsion Trauma • Hematocele (blood within the tunica vaginalis) • Intratesticular hematoma • Laceration of the tunica albuginea • Testicular rupture Varicocele Key Historical Features Onset and duration of pain Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Gynecomastia Abnormal head size and shape Musculoskeletal pain Seizures Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Pediatrics Jun 18, 2016 | Posted by admin in PEDIATRICS | Comments Off on Acute scrotum Full access? Get Clinical Tree
Chapter 3 ACUTE SCROTUM Theodore X. O’Connell General Discussion Every male patient with the acute onset of pain and swelling of the scrotum requires an immediate evaluation to diagnose or exclude testicular torsion. Of the cases of acute painful scrotum, 30% are caused by testicular torsion. Testicular torsion represents a true surgical emergency because the likelihood of testicular salvage decreases as the duration of torsion increases. The rate of testicular salvage is highest with symptoms 6 or fewer hours in duration. In children in whom the duration of symptoms is short and in whom clinical history and physical examination strongly suggest the diagnosis of acute testicular torsion, imaging studies may be bypassed in favor of surgical exploration. The age of the child may help guide the evaluation. Testicular torsion may occur at any age but is more common during the newborn period and during early puberty. Appendiceal torsion and Henoch-Schönlein purpura are more common in prepubertal boys. Epididymitis is more common in adolescents and young adults. The abrupt onset of severe pain is characteristic of testicular torsion. Mild to moderate pain that develops over several days is more suggestive of epididymitis or appendiceal torsion. An acute scrotal process may be referred to the abdomen, so any child presenting with an acute abdomen must have a complete genital examination. Causes of Acute Scrotal Pain Acute idiopathic scrotal edema Allergic reaction Appendiceal torsion Epididymitis Henoch-Schönlein purpura Hydrocele Inguinal hernia Insect bite Orchitis Testicular torsion Trauma • Hematocele (blood within the tunica vaginalis) • Intratesticular hematoma • Laceration of the tunica albuginea • Testicular rupture Varicocele Key Historical Features Onset and duration of pain Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Gynecomastia Abnormal head size and shape Musculoskeletal pain Seizures Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Pediatrics Jun 18, 2016 | Posted by admin in PEDIATRICS | Comments Off on Acute scrotum Full access? Get Clinical Tree
