[Acute idiopathic scrotal oedema in young boys: A report of ten cases and a review of the literature]

Abstract

Background: acute idiopathic scrotal oedema (AISO) is most commonly seen in boys aged between 5 and 10 years. It comprises a benign dermatosis of spontaneously favourable outcome but requiring surgical exploration in some cases in order to rule out testicular torsion. Our retrospective study of a series of 10 children presenting AISO allowed us to set out the specific features of this dermatological disorder well-known to paediatric surgeons, but concerning which only one publication exists in the dermatology literature.

Patients and methods: this was a retrospective study of the files of all children seen in the paediatric surgery department of Reims University Hospital between 1996 and 2008 for acute scrotal oedema. Diagnosis of AISO was made on the basis of clinical criteria after ruling out potential differential diagnosis. The demographic, clinical and laboratory data were collated from patient files. Long-term outcome was determined by means of telephone calls.

Results: among 185 cases of acute scrotal disease, 10 cases of AISO (5.4%) were identified. The mean age at onset of the initial episode was 6 years (range: 3 to 12 years). Oedema was unilateral in eight cases and bilateral in two cases; there was involvement of the inguinal folds, the perineum and the homolateral buttock in three cases, and of the penis in one case. The skin was erythematous and relatively non-inflamed in all but one case. Non-focal scrotal pain was present on palpation in nine cases. General health status was unimpaired and none of the children presented any associated signs. White cell count was between 7000 and 12000 per millimeter cube, with no neutrophil polynucleosis or inflammatory syndrome; in three cases, hypereosinophilia was between 700 and 2300 per millimeter cube. Two patients underwent surgical exploration to rule out testicular torsion; Doppler ultrasound was performed in the remaining eight cases and no surgery was required in six cases. In all cases, a favourable outcome was attained within 2 to 3 days and there were no sequelae. Five children presented a total of 21 recurrences (between three and eight per child) over a maximum period of 12 years.

Discussion: the clinical characteristics of our patients are entirely consistent with the descriptions given in the literature. The chief problem with AISO is differential diagnosis; in this respect, Doppler ultrasound may be useful in obviating surgical investigation for testicular torsion. Treatment involves bed rest and analgesics where necessary; a rapidly favourable outcome is achieved within 2 to 3 days, but relapse occurs in at least 20% of cases, although these were more frequent and more numerous in our series. The aetiopathogenesis has not yet been fully elucidated.

Conclusion: Identification of AISO, a fairly stereotypical though misunderstood diagnostic entity, is useful in order to avoid unwarranted medical treatment and, above all, unnecessary surgical exploration.