Scrotum



Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_67
© Springer International Publishing Switzerland 2014


Acute Scrotum



Jared M. Bieniek  and Joel M. Sumfest 


(1)
Department of Urology, Geisinger Medical Center, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA

(2)
Department of Pediatric Urology, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA

 



 

Jared M. Bieniek



 

Joel M. Sumfest (Corresponding author)



Abstract

Acute pediatric scrotum, caused by a variety of etiologies, is the presentation of new onset scrotal pain, tenderness, or swelling in children less than 18 years-old.


Acute pediatric scrotum, caused by a variety of etiologies, is the presentation of new onset scrotal pain, tenderness, or swelling in children less than 18 years-old.

1.

Pathophysiology:

(a)

Testicular torsion: All acute scrotum presentations should be considered testicular torsion until proven otherwise.

 

(b)

Appendix testis/epididymis torsion.

 

(c)

Epididymitis/orchitis.

 

(d)

Cellulitis/Fournier’s gangrene.

 

(e)

Inguinal hernia/hydrocele.

 

(f)

Varicocele.

 

(g)

Traumatic contusion, hematocele, or rupture.

 

(h)

Testicular/scrotal mass.

 

(i)

Referred pain (e.g. ureteral obstruction).

 

(j)

Other: idiopathic scrotal edema, insect bite, vasculitis.

 

 

2.

Clinical presentation:

(a)

Age:

(i)

Infancy to puberty: Appendage torsion most common.

 

(ii)

Perinatal and pubertal periods: Epididymitis and testicular torsion common.

 

 

(b)

Onset, quality, duration.

 

(c)

Precipitating/relieving factors: Relation to activity/trauma.

 

(d)

Prior similar episodes.

 

(e)

Associated symptoms such as fever, nausea/vomiting, hematuria, dysuria, discharge.

 

(f)

Recent illnesses.

 

(g)

Medical and surgical history.

 

(h)

Sexual history.

 

 

3.

Physical examination:

(a)

Symptoms may be referred to the scrotum therefore evaluation should include complete abdominal and back/flank examination as well as genitourinary examination.

 

(b)

Penile examination for circumcision status or other meatal abnormalities which may predispose to urinary infections.

 

(c)

Scrotal exam:

(i)

Skin:

1.

Examine for erythema, bruising, warmth, tenderness, swelling, crepitus, and discharge.

 

2.

Local erythema, warmth, crepitus, or discharge raises concern for a scrotal skin/subcutaneous infection.

 

3.

Cremasteric reflex: Normal reflexive retraction of the hemiscrotum with light stroke of the ipsilateral inner thigh in patients >2-years-old. Absence of this reflex raises concern for spermatic cord torsion.

 

4.

Blue dot sign: Torsion of testicular appendage may produce blue discoloration seen through scrotal skin stretched over upper pole of the affected testicle.

 

 

(ii)

Testicles:

1.

Examine normal and affected side for tenderness, firmness, size, position, lie, and masses.

(a)
Jan 7, 2017 | Posted by in PEDIATRICS | Comments Off on Scrotum

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