(Background) The acute scrotum in children frequently presents a diagnostic dilemma. The objective of this study is to review the experience of patients with acute scrotum in children.
(Methods) From April 1986 until March 1998, we encountered 40 cases of acute scrotum in children less than 15 years old diagnosed by surgical exploration.
(Results) Final diagnoses consisted of 14 patients with torsion of the spermatic cord (35%), 22 patients with torsion of the testicular appendage (55%), 3 patients with acute epididymitis (7.5%), and patient with a strangulated hernia (2.5%). Of 22 patients with torsion of the testicular appendage, which were the most frequent cause of acute scrotum, 20 had torsion of the testicular appendix and 2 had torsion of the epididymal appendix. The age distribution of the patients with torsion of the spermatic cord was biphasic, with the highest frequencies occurring in patients 2 years old and 14 years old. In contrast, the age distribution of patients with torsion of appendage showed a single peak incidence at 9 years of age. Those with epididymitis were younger than 2 years old. Of 14 cases of torsion of the spermatic cord, orchiectomy was performed in 6 cases (42.9%) because of testicular necrosis.
(Conclusion) Although surgical exploration is no longer necessary for all patients with torsion of the appendage, this review revealed that patients complaining of severe or persistent pain usually require surgery to diagnose and treat the problem.