Acute Scrotum in Children:A Review Article

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Acute Scrotum in Children:A Review Article

Journal Title: Progressing Aspects in Pediatrics and Neonatology - Year 2018, Vol 1, Issue 3

Abstract

Acute scrotal conditions are common clinical concern in infants and children. The true cause is difficult to determine. There are several etiologic factors for this syndrome. These are torsion of the testis (TT), torsion of the testicular appendix (TTA), epididymo- orchitis (EO) and strangulated inguinoscrotal hernia (SIH). It is generally admitted that EO is rare in children and is associated with structural anomalies of the urinary tract. The aim of this study is to review the various causes of pediatric acute scrotal conditions and to assess management of these patients under the light of relevant literature.Acute scrotal conditions are common in children. It presents with scrotal pain, swelling, redness in the affected hemiscrotum. The true cause is difficult to determine. There are myriad etiologies for this syndrome and these are torsion of the testis (TT), torsion of the testicular appendix (TTA), epididymo-orchitis (EO) and strangulated inguinoscrotal hernia (SIH) [1-3]. General belief is that EO is rare in children and is associated with structural anomalies of the urinary tract [4-6]. The aim of this study is to review the various causes of pediatric acute scrotal conditions and to assess management of these patients under the light of relevant literature. Every boy with acute onset scrotal pain and swelling requires immediate evaluation. Commonest causes of acute scrotum in children are TT, EO, TTA [1-3,7]. Various incidences have been reported regarding the etiology of pediatric acute scrotum [1-3]. True incidence of these causes in acute scrotum is unclear, EO is thought to be uncommon [8].Traditional teaching suggests that EO is rare in children and occurs more frequently among late adolescents [2,3,5,9,10]. Contrary to these previously published reports, it has been reported that only 22.7% of patients with EO were found to be around peripubertal age group [11]. The incidence of positive urinalysis (13.6%) in Erikci's series [11] shows similarity with those reported previously, incidences of which were between 15%-59% [2,5,1214]. However, urine culture proven infection rate of 51.6% has also been reported in children with epididymitis [15]. An associated urologic abnormality should be kept in mind in these patients. In a recent series [11] the incidence of underlying urogenital anomaly in patients with EO was reported to be 22.7% showing similarity with previous reports [5,16,17]. There is controversy if all the patients with EO should undergo investigation of the urinary tract. It has been recommended that all boys with EO should be evaluated for urogenital anomalies [3]. Others suggest further urological assessment only in children with high risk of urinary anomalies [1,7,17]. On the other hand it was reported that selective use of VCUG and renal scintigraphs was possible in these patients with the aid of routine urinalysis and urine culture with urinary USG and this was found to be cost effective [11].

Authors and Affiliations

Volkan Sarper Erikci, Tunç Özdemir

Keywords

Scrotum; Epididiymo-Orchitis Strangulated Inguinal Hernia; Testis Torsion; Torsion of Testicular Appendage; Torsion of an Epididymal Cyst; EC: Epididymal Cyts

EP ID EP576401
DOI 10.32474/PAPN.2018.01.000114
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