EVALUATION OF ACUTE SCROTUM IN THE EMERGENCY DEPARTMENT

A 2-year retrospective review of 238 cases of acute scrotal pain encou ntered in a children's hospital emergency department is presented. The incidences of testicular torsion, torsion of a testicular appendage, and epididymitis were 16%, 46%, and 35%, respectively. Testicular salv age was critically dependent on the interval between onset of pain and surgical intervention. No testis likely to have been viable at the ti me of presentation was ''lost.'' The diagnostic error rate on first en counter was 7%, resulting in 10 negative scrotal explorations. With th e exception of cases of far-advanced necrotic testes, both color Doppl er ultrasound and radioisotope imaging were highly specific diagnostic modalities. Thirty-nine percent of the children with epididymitis who underwent investigation were found to have either structural or funct ional urinary tract abnormalities. Noninvasive urodynamic studies appe ar to be useful screening modalities in older children with epididymit is. Copyright (C) 1995 by W.B. Saunders Company