Abstract
Background/Purpose: Surgical exploration has been recommended in all children with acute scrotum. Torsion of the testis (TT) is a surgical emergency because the likelihood of testicular salvage decreases as the duration of torsion increases. However, in many situations, the history, the clinical examination as well as the colour Doppler ultrasonography (DUS) study does not support the diagnosis of TT; and yet many pediatric surgeons still go for surgery in such cases. The aim of this study is to find out if this policy is justified.
Materials & Methods: This is a retrospective study of cases of acute scrotum managed by the authors over a period of 7 years. The files were reviewed regarding the history, the clinical examination, DUS findings; if done, and findings at surgery; if done. Cases were divided into 3 groups; I: cases with clinical picture suggestive or doubtful of TT treated surgically, II: cases with clinical picture not suggestive of TT, treated surgically, and group III: cases with clinical picture, with DUS, not suggestive of TT and treated conservatively. Findings at follow up (range 3 - 6 months) were also reported.
Results: Fifty-five cases of acute scrotum were managed by the authors. In Group I (34 Cases), 17 cases (50%) were found to have TT at surgery; 7 cases (41%) had orchidectomy for gangrenous testes and in 10 cases (59%) the testes could be salvaged. The remaining cases had testicular appendages torsion (TAT) (7) (20.5%), epididymitis (EP) (4) (11.7%), and strangulated inguinal hernia (6) (17.6%). In group II (10 Cases); although the clinical picture did not suggest TT, however, based on the principle that "acute scrotum should be explored", surgical exploration was done. At surgery; 4 cases (40 %) had TAT and (4) (40%) had EP and 2 cases (20%) had infected hydroceles. No case had TT. In group III (11 Cases); the clinical picture was not suggestive of TT, and the DUS showed normal or increased vascularity to the central parts of the testes; cases were treated conservatively; (8)(72.7%) as EP, 2 (18%) as trauma and (1)(9%) as idiopathic scrotal edema. They were followed up for 3-6 months. All showed normal testicular size.
Conclusion: If any doubt exists regarding the possibility of TT, emergency scrotal exploration should be done without any delay. However, in situations where the clinical picture is not suggestive of TT and the DUS showed normal or increased vascularity to the central part of the testis, we believe that scrotal exploration is not justified.