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Review
. 2012 Jun;109(25):449-57; quiz 458.
doi: 10.3238/arztebl.2012.0449. Epub 2012 Jun 22.

The acute scrotum in childhood and adolescence

Patrick Günther  1 , Iris Rübben
Affiliations
Review

The acute scrotum in childhood and adolescence

Patrick Günther et al. Dtsch Arztebl Int. 2012 Jun.

Abstract

Background: The acute scrotum in childhood or adolescence is a medical emergency. Inadequate evaluation and delays in diagnosis and treatment can result in irreversible harm, up to and including loss of a testis. Various diseases can produce this clinical picture. The testis is ischemic in only about 20% of cases.

Methods: This review is based on a selective literature search, the existing clinical guideline, and the authors' experience.

Results: The clinical approach to the acute scrotum must begin with a standardized, rapidly performed diagnostic evaluation. Dopper ultrasonography currently plays a central role. Its main use is to demonstrate the central arterial blood supply and venous drainage of the testis. The resistance index of the testicular vessels should also be determined.

Conclusion: Physical examination and properly performed Doppler ultrasonography enable adequate evaluation of the acute scrotum in childhood and adolescence. In the rare cases of diagnostic uncertainty, immediate surgical exposure of the testis remains the treatment of choice.

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Figures

Figure 1
Figure 1
Acute scrotum (left side) in an infant
Figure 2
Figure 2
Doppler ultrasonographic demonstration of testicular parenchymal perfusion with flow-curve registration in the triplex mode. a) central arterial and b) venous perfusion (with the kind permission of PD Dr. J. P. Schenk, pediatric radiology, Dept. of Diagnostic and Interventional Radiology, Heidelberg).
Figure 3
Figure 3
Intravaginal testicular torsion a) Intraoperative findings in intravaginal testicular torsion in a 15-year-old boy b) Histological section of the removed testicle with hemorrhagic necrosis and extensive erythrocyte extravasation in the interstitial tissue. There are also degenerating testicular canals with centripetal maturation of spermiogenesis
Figure 4
Figure 4
Hydatid torsion. Ultrasonographic demonstration of a round, hyperechogenic, non-perfused structure (marked) next to the upper pole of the testicle: hydatid in torsion (with the kind permission of PD Dr. J. P. Schenk, pediatric radiology, Dept. of Diagnostic and Interventional Radiology, Heidelberg)
Figure 5
Figure 5
Ultrasonography of idiopathic scrotal edema in a six-year-old boy. Typically, the scrotal wall is edematous and enlarged on both sides and hyperperfused in places; individual layers can no longer be distinguished
Figure 6
Figure 6
The diagnostic evaluation of the acute scrotum in childhood and adolescence RI, resistance index; DD, differential diagnosis
See this image and copyright information in PMC

Comment in

  • Pain may present in variable ways.
    von Zastrow C. von Zastrow C. Dtsch Arztebl Int. 2013 Jan;110(3):41. doi: 10.3238/arztebl.2013.0041a. Epub 2013 Jan 18. Dtsch Arztebl Int. 2013. PMID: 23413383 Free PMC article. No abstract available.
  • Testicular torsion masked by painful abdomen.
    Santos M, Kohl M. Santos M, et al. Dtsch Arztebl Int. 2013 Jan;110(3):41. doi: 10.3238/arztebl.2013.0041b. Epub 2013 Jan 18. Dtsch Arztebl Int. 2013. PMID: 23413384 Free PMC article. No abstract available.
  • In reply.
    Günther P. Günther P. Dtsch Arztebl Int. 2013 Jan;110(3):42. doi: 10.3238/arztebl.2013.0042. Epub 2013 Jan 18. Dtsch Arztebl Int. 2013. PMID: 23413385 Free PMC article. No abstract available.

References

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