Differential diagnosis

Acute disease of scrotum (Acute scrotum)

The acute scrotum presents as acute painful swelling of scrotum or its contents.

The "acute scrotum" may be viewed as the urologist's equivalent to the general surgeon's "acute abdomen." Both conditions are guided by similar management principles:

v The patient history and physical examination are key to the diagnosis and often guide decision making regarding whether or not surgical intervention is appropriate.

v Imaging studies should complement, but not replace, sound clinical judgment.

v When making a decision for conservative, non-surgical care, the provider must balance the potential morbidity of surgical exploration against the potential cost of missing a surgical diagnosis.

v A small but real, negative exploration rate is acceptable to minimize the risk of missing a critical surgical diagnosis.

A list of potential medical conditions that can present as acute pain or swelling of the scrotum are found in Table 8.3

Table 8.3

Causes of Acute Scrotal Pain and Swelling

(according to the American Urological Association, 2013)

Ischemia:	· Torsion of the testis (synonymous with torsion of the spermatic cord) Intravaginal; extravaginal (prenatal or neonatal) · Appendiceal torsion, testis or epididymis · Testicular infarction due to other vascular insult (cord injury, thrombosis)
Trauma:	· Testicular rupture · Intratesticular hematoma, Hematocele · Testicular contusion
Infectious conditions:	· Acute epididymitis · Acute epididymoorchitis · Acute orchitis · Abscess (intratesticular, intravaginal, scrotal cutaneouscysts) · Gangrenous infections (Fournier’s gangrene)
Inflammatory conditions:	· Henoch-Schonlein purpura (HSP) vasculitis of scrotal wall · Fat necrosis, scrotal wall
Hernia:	Incarcerated, strangulated inguinal hernia, with or without associated testicular ischemia
Acute on chronic events:	· Spermatocele, rupture or hemorrhage · Hydrocele, rupture, hemorrhage or infection · Testicular tumor with rupture, hemorrhage, infarction or infection · Varicocele

Acute scrotum is a paediatric urology emergency case, most commonly caused by torsion of the testis, torsion of the appendix testis and epididymitis/epididymoorchitis. Other causes of acute scrotal pain are idiopathic scrotal oedema, mumps orchitis, varicocele, scrotal haematoma, incarcerated hernia, appendicitis or systemic disease (Henoch-Schônlein purpura).

While the differential diagnosis is broad, an accurate history and physical examination can frequently precisely define the condition. Often, carefully chosen imaging studies can compliment clinical judgment and expedite therapeutic decisions.

Any acute scrotal pain requires immediate surgical assessment for torsion of the testis or strangulated inguinal hernia, which are surgical emergencies. In practice it is often difficult to be certain of the diagnosis clinically i.e. sometimes the diagnosis may only be made by surgical exploration.

The child's age suggests the cause of the acutely painful scrotum because torsion of the appendix testes/epididymis is more common in prepubertal boys and spermatic cord torsion (torsion of the testis) occurs more frequently in adolescents and newborns.

Дата добавления: 2014-10-15