DO ALL CHILDREN WITH AN ACUTE SCROTUM REQUIRE EXPLORATION

A total of 77 consecutive children ranging in age from 1 day to 17 yea rs was evaluated for an acute scrotum by a single examiner (E. J. K.). In 10 children a definite diagnosis of acute spermatic cord torsion w as made based upon the history and physical examination. No imaging st udies were performed and torsion was confirmed at surgery in 9 childre n. The diagnosis of testis torsion was not as clear-cut in the remaini ng 67 children and, therefore, a color Doppler ultrasound was performe d before any surgical intervention. The study demonstrated normal or i ncreased blood flow in 55 of these children and none proved to have te sticular torsion, although other scrotal pathology requiring surgery w as noted in 5 children. Twelve children did not demonstrate evidence o f testicular blood flow on the color Doppler ultrasound and all had su rgical confirmation of testis torsion. We conclude that in our experie nce the majority (71%) of children with an acute scrotum did not requi re immediate surgical exploration. Color Doppler ultrasound can reliab ly identify those children with an acute scrotum who require explorati on and spare the majority needless surgery. Routine scrotal exploratio n is no longer necessary for all children with an acute scrotum.