Abstract
The aim of the study was to compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis compared to testicular torsion and torsion of the appendix testes. A retrospective review of the medical records of 66 boys presenting with clinical aspects of acute scrotum over a 3-year period was performed. Sixty-six patients were included in the study (29 with epididymitis, 8 with testicular torsion and 12 with torsion of the appendix testis, 4 with scrotal abscesses, 5 with scrotal swelling, and 1 with inflamed epididymal cyst). The duration of symptoms ranged from 6 h to 4 days with a peak on the second day. Urine cultures and viral testes were negative in all patients. Color Doppler ultrasound was diagnostic for epididymitis in 28 patients (96.6%). Systemic intravenous antibiotics were given in all 29 patients with epididymitis. No patient showed signs of testicular atrophy in the follow-up. The increasing incidence of epididymitis should question the policy of routine exploration of the acute scrotum in children. The history and physical examination cannot reliably identify those boys who can be managed conservatively. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal but it can also be misleading.
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References
Bentley DF, Ricchiuti DJ, Nasrallah PF, McMahon DR (2004) Spermatic cord torsion with preserved testis perfusion: initial anatomical observations. J Urol 172:2373–2376
Bukowski TP, Lewis AG, Reeves D, Wacksman J, Sheldon CA (1995) Epididymitis in older boys: dysfunctional voiding as an etiology. J Urol 154:762–765
Cappele O, Liard A, Barret E, Bachy B, Mitrofanoff P (2000) Epididymitis in children: is further investigation necessary after the first episode. Eur Urol 38:627–630
Catti J, Murphy JP (2007) Current management of the acute scrotum. Semin Pediatr Surg 16:58–63
Davis WH, Scardino PL (1972) Meningitis presenting as epididymitis. South Med J 65:936
Gierup J, Von Hedenberg C, Osterman A (1975) Acute non-specific epididymitis in boys. A survey based on 48 consecutive cases. Scand J Urol Nephrol 9:5–9
Gislason T, Noronha RFX, Gregory JG (1980) Acute epididymitis in boys: a 5-year retrospective study. J Urol 124:533–534
Haecker MF, Hauri-Hohl A, von Schweinitz D (2005) Acute epididymitis in children: a 4-year retrospective study. Eur J Pediatr Surg 15:180–186
Hutchenson J, Peters C, Diamond D (1998) Amiodarone induced epididymitis in children. J Urol 160:515–517
Kalfa M, Veyrac C, Baud C, Coutare A, Averous M, Galifer RB (2004) Ultrasonography of the spermatic cord in children with testicular torsion. Impact on the surgical strategy. J Urol 172:1692–1695
Karmazyn B, Steinberg R, Kornreich L, Freud E, Grozovski S, Schwarz M, Ziv N, Livne P (2005) Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. Pediatr Radiol 35(3):302–310
Karmaryn B, Steinberg R, Livne P (2006) Duplex sonographic findings in children with torsion of testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg 41(3):500–504
Kass EJ, Stone KT, Cacciareli AA, Mitchell B (1993) Do all children with an acute scrotum require exploration? J Urol 150:667–669
Kiviat MD, Shurtleff D, Ansell JS (1972) Urinary reflux via the vas deferens: unusual cause of epididymitis in infancy. J Pediatr 80:476–479
Lewis A, Bukowski T, Jarvis P, Wacksman J, Sheldon C (1995) Evaluation of acute scrotum in the emergency department. J Pediatr Surg 30:277–281
Likitnukul S, McCracken GH, Nelson JD, Votteler TP (1987) Epididymitis in children and adolescents. A 20-year retrospective study. Am J Dis Child 141:41–44
McAndrew FM, Pemberton P, Kikiros CS, Collaw I (2002) The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int 18:435–437
Melekos M, Asbach H, Markou S (1988) Etiology of acute scrotum in 100 boys with regard to age distribution. J Urol 139:1023–1025
Melloul M, Paz A, Lask D, Manes A, Mukamel A (1995) The value of radionuclide scrotal imaging in the diagnosis of acute testicular torsion. Br J Urol 76:628–631
Nussbaum Blask AR, Bulas D, Shalaby-Rana E, Rushton G, Shao G, Majo M (2002) Color Doppler sonography and scintigraphy of the testis: a prospective comparative analysis in children with acute scrotal pain. Pediatr Emerg Care 18(2):67–71
Siegel A, Snyder H, Duckett JW (1987) Epididymitis in infants and boys. Underlying urogenital anomalies and efficacy of imaging modalities. J Urol 138:1100–1103
Somekh E, Gorenstein A, Serour F (2004) Acute epididymitis in boys: evidence of a post-infectious etiology. J Urol 171:391–394
Stehr M, Boehm R (2003) Critical validation of colour Doppler ultrasound in diagnostics of acute scrotum in children. Eur J Pediatr Surg 13:386–392
Varga J, Zivkovic D, Grebeldinger S, Somer D (2007) Acute scrotal pain in children—ten years’ experience. Urol Int 78:73–77
Waldman L, Kosloske A, Parsons D (1977) Acute epididymoorchi-tis as the presenting manifestation of Hemophilus influenzae septicemia. J Pediatr 90:87–89
Wu H, Sun Sh, Kao A, Chuang F, Chieh C, Lee C (2002) Comparison of radionuclide imaging and ultrasonography in the differentiation of acute testicular torsion and inflammatory testicular disease. Clin Nucl Med 27(7):490–493
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Sakellaris, G.S., Charissis, G.C. Acute epididymitis in Greek children: a 3-year retrospective study. Eur J Pediatr 167, 765–769 (2008). https://doi.org/10.1007/s00431-007-0584-y
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DOI: https://doi.org/10.1007/s00431-007-0584-y