A prospective study of clinical profile and management of acute scrotum in different age groups
Journal Title: INTERNATIONAL JOURNAL OF RECENT TRENDS IN SCIENCE AND TECHNOLOGY - Year 2016, Vol 20, Issue 3
Abstract
Introduction: Acute scrotum is a clinical syndrome which includes any condition of scrotum or scrotal contents requiring emergency medical or surgical intervention, because acute scrotal pathology can result in testicular infarction and necrosis, testicular atrophy, infertility, persistent testicular pain and significant morbidity. This study aims to know different causes and clinical features of acute scrotum and its management. Methods: The study was prospective study conducted at RCSM GMC, Kolhapur. A total of 70 patients who presented with acute scrotal pain from 8 August 2013 – 28 February 2015 were recruited for the study. Results: The mean age of patients in the study 37.28 years. Of the 70 patients included, 17 (24.28%) had torsion testis (TT), 4 (5.71%) had torsion of appendix of testis (T Ta), 26 (37.14%) had Epididymitis and epididymo-orchitis (E/EO), 15 (21.42%) had Fournier's gangrene (FG), 4 (5.71%) had scrotal abscess (Sab), 3 (4.28%) had scrotal hematoma (SH) and 1(1.42%) patient had obstructed inguinal hernia (OH). Most common cause of acute scrotum is epididymo-orchitis and epididymitis followed by testicular torsion, Fournier's gangrene, torsion of appendix testis, scrotal abscess, scrotal hematoma and rare causes such as obstructed inguinal hernia. In case of torsion testis, surgical exploration undertaken without delay increases the chance of testicular salvage. Epididymitis and epididymo-orchitis is most common cause of acute scrotum in young adults and middle aged men. Fournier’s gangrene as a cause of acute scrotum is most common in old age group and diabetes mellitus is a major risk factor for this etiology. Conclusions: Acute scrotum is a common surgical emergency. Ultra sonography and colour Doppler ultrasound are imaging modality of choice in acute scrotum. In case of torsion testis, the 6 hour time limit is not fixed and even in late presentations up to 12 hours, the testicle may be salvageable if emergent scrotal exploration done. Most common pathogen causing epididymo orchitis in young adults is C. trachomatis. Epididymo-orchitis is rare in children and most common pathogen causing it in children and older age group is E. coli. Immediate surgical debridement, better facilities of hospital care, better antibiotics and supportive care decreases mortality in Fournier's gangrene cases.
Authors and Affiliations
Shivprasad Hirugade, Sagar Naik, Harish N Patil, Shilpa S Hirugade
Keywords
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