Acute scrotum
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An acute scrotum is the occurrence of severe pain and associated symptoms in the testicle, usually but not exclusively in young boys. Related to the term acute abdomen, it indicates the requirement for urgent diagnosis and adequate treatment.
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[edit] Causes
The most severe condition that can present as an acute scrotum is testicular torsion, in which the testicle rotates around its vascular supply with risk of long-term damage. There is usually a more sudden onset of pain compared to other common causes of acute scrotum.
Epididymitis is the most frequent cause of sudden scrotal pain. Other conditions that can cause acute scrotal pain are torsion of a testicular appendage (in which the pain can be localised to the upper pole of the testis, sometimes with a blue dot sign), injury, orchitis or other infections inside or around the scrotum (including tuberculosis and Fournier's gangrene), inguinal hernia, hydrocele, varicocele and spermatocele. Rare causes include Henoch-Schönlein purpura and sickle cell disease. Testicular cancer can lead to acute scrotal pain if there is necrosis (tissue death) or hemorrhage. Another condition that can present as acute scrotum is idiopathic scrotal edema, a benign swelling of the scrotum of unknown cause.
As time progresses, swelling and increasing pain can lead to a convergence of different conditions into one similar clinical picture.
[edit] Diagnosis
The cremaster reflex (elevation of the testicle in response to stroking the upper inner thigh) is typically preserved in epididymitis but can be absent in testicular torsion, with the testis already elevated spontaneously. If the scrotal pain is relieved by elevation of the testicle, Prehn's sign is said to be positive, which suggests epididymitis rather than testicular torsion.
Useful medical tests are usually performed in hospital and include urinalysis (usually normal in testicular torsion) and ultrasound if available.[1] Pyuria and bacteriuria (pus and bacteria in the urine) in patients with acute scrotum suggests an infectious cause such as epididymitis. If the diagnosis is not entirely clear from the patient's history and physical examination, a Doppler ultrasound scan can confirm increased flow of blood to the affected epididymis.
If there is a swelling of the scrotum, translucency with a small light source can determine the nature of the contents (clear fluid, hernia, blood as in hemoscrotum, ...).
[edit] Treatment
Suspected testicular torsion requires surgery within hours of the appearance of symptoms, as the risk of damage increases over time.[1][2]
[edit] References
- ^ a b Galejs LE (February 1999). "Diagnosis and treatment of the acute scrotum". American Family Physician 59 (4): 817–24. PMID 10068706. http://www.aafp.org/afp/990215ap/817.html.
- ^ Mäkelä E, Lahdes-Vasama T, Rajakorpi H, Wikström S (2007). "A 19-year review of paediatric patients with acute scrotum". Scandinavian Journal of Surgery 96 (1): 62–6. PMID 17461315.
