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
(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
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.
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Examine normal and affected side for tenderness, firmness, size, position, lie, and masses.
(a)
Differentiate tenderness of testicle vs. epididymis or both.
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