The Diagnosis and Treatment of the Acute Scrotum in Children and Adolescents

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Abstract
Diagnosing acute scrotal pain and swelling in children and adolescents is urgent and often difficult. A review of 395 boys hospitalized with acute scrotal pain and/or swelling shows that a useful approach is to divide these patients into 4 groups: intermittent but recurrent pain, pathognomonic physical findings, definite epididymitis, and nonspecific swelling and tenderness. Boys in this series with recurring scrotal pain (5%) should udnergo a simple scrotal operation that yields excellent results. Treatment in boys with pathognomic physical findings (8%) is straightforward. Some 18% had a definite acute epididymitis diagnosis (i.e., 3 nonpathognomonic but suggestive acute epididymitis findings or 2 suggestive findings plus a radionuclide scan showing bilateral perfusion). Nonoperative therapy is indicated in this group. In the remaining boys,scrotal exploration is the diagnostic (and usually therapeutic) procedure of choice.

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