CRITICAL ANALYSIS OF THE CLINICAL PRESENTATION OF ACUTE SCROTUM - A 9-YEAR EXPERIENCE AT A SINGLE INSTITUTION

Purpose: We assessed the significance of the clinical presentation of boys who underwent surgical exploration for acute scrotum. Materials a nd Methods: We retrospectively analyzed the records of 115 consecutive boys who underwent surgical exploration for acute scrotum between Oct ober 1986 and January 1996. We divided the children into group 1 - 83 with spermatic cord torsion a mean of 14.4 years old, group 2 - 27 wit h torsion of a testicular appendage a mean of 9.4 years old and group 3 - 5 with epididymo-orchitis a mean of 14.1 years old. Particular att ention was given to nausea and vomiting, patient age and duration of p ain. Results: Nausea and vomiting occurred in 69 and 60% of the boys i n group 1, 8 and 4% in group 2 and none in group 3. Nausea and vomitin g had positive predictive values of 96 and 98%, respectively, for sper matic cord torsion. Only 6 of the 83 boys (7%) with spermatic cord tor sion were younger than 11 years, whereas 15 of the 27 (56%) with torsi on of a testicular appendage were younger than II years. Of the 83 boy s with spermatic cord torsion the testes were salvaged in 51 (61%) and the duration of pain was 40 minutes to 12 hours (mean 4 hours). The t estes were not salvaged in any patient with greater than 12 hours of p ain. Conclusions: We believe that any boy 11 years old or older with s crotal pain less than 12 hours in duration that is associated with nau sea or vomiting should be considered to have torsion of the spermatic cord. In this day of cost-effective medical management it is not neces sary to perform imaging in this subset of boys before surgical explora tion.