Acute Scrotum in Children: An 18-Year Retrospective Study

Purpose: This study aimed to compare clinical manifestations, physical examination findings, laboratory, and radiographic dates in pediatric patients with different pathological diagnoses of acute scrotum as well as to accurately establish the true incidence of various pathological diagnoses of acute scrotum. Methods: The records of children hospitalized for acute scrotum from 1990 to 2008 were reviewed. Results: A total of 1228 cases were included in the study (103 with testicular torsion, 918 with torsion of the testicular appendix, 72 with tunica vaginalis inflammation, 46 with epididymitis and 89 with other pathological diagnoses). Duration of pain less than 6 hours, fever, vomiting, history of trauma or activities, absence of cremasteric reflex, and abnormal testicle direction were significantly associated with testicular torsion. Blue dot sign and tender nodule were found significantly associated with torsion of the testicular appendix. Ultrasound showed decreased or absent blood flow in 91.3% testicular torsion patients; enlarged epididymis was found in 91.1% and 91.3% patients with torsion of the testicular appendix and epididymitis, respectively; and scrotal wall edema and hydrocele were found significantly associated with tunica vaginalis inflammation. Our salvageability rate in testicular torsion was 30.1%. Conclusions: Overlap existed between testicular torsion and other acute scrotum. The clinical manifestations, physical examination findings, laboratory, and radiographic data were helpful in distinguishing acute scrotum. Doppler ultrasound is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; in the presence of a clinical suspicion of testicular torsion, even with an apparently normal-color Doppler ultrasound, surgical exploration is still indicated.