Acute Scrotal Swelling
Acute Scrotal Swelling
Anum Salam, Gillian Winter
Created: February 2023
Tag year: Year 4
Tag speciality: Paediatric surgery
Tag condition: Testicular torsion
Learning Aim
•
To develop a greater understanding of the presentation and management of an acute scrotal
swelling in the paediatric population
Presentation
•
A 15-year-old boy is admitted to
the emergency department with
scrotal pain at 2:30pm.
•
Mum reports he was well when
he woke up this morning,
but when he was outside playing
football he suddenly started
complaining about this pain.
List 8
differentials
What do you want
to know about the
pain?
•
Site – right side of scrotum
•
Onset – started suddenly and reached
maximal intensity within a few minutes
•
Character – throbbing
•
Radiation – no
•
Associated symptoms- felt nauseous
and vomited twice, no urinary symptoms
•
T- has been present since it started 2 hours ago
•
E- nothing makes it better, moving makes it
worse
•
Severity- 9/10
This Photo
by Unknown author is licensed under
CC BY-SA-NC
.
Narrow
down to 5
differentials
Any other questions
•
PMH- usually fit and well, normal
pregnancy and birth, reached all his
developmental milestones and up to
date with immunizations
•
Not on any regular medication, no
previous admissions, no past surgeries,
no allergies
•
FH- nil noted
•
SH- lives with his one brother and
parent in a house, not sexually active
What would you like to do next?
•
Testicular exam video:
Testicular Examination - OSCE Guide - YouTube
What would you expect to find for each
differential?
•
testicular torsion (1,8,7)
•
torted hydatid
of Morgagni, (2,4,7,5,8,9)
•
Epididymitis (3,6,7,5,9)
•
1 sudden pain
•
2 gradual pain
•
3 pain develops over a few days
•
4 blue spot
•
5 normal cremasteric reflex
•
6
Frequent and painful micturition
•
7 swelling of scrotum
•
8 Prehn's sign negative
•
9 normal testicular lie
Back to our child
•
On examination you see a swollen, erythematous testicle that is high
riding with a horizontal lie. Very tender to palpation. The cremasteric
reflex is absent.
What is
your top
differential
Investigations
•
Which investigation is routinely used to diagnose testicular torsion?
•
Doppler ultrasound
•
Urinalysis
•
X-ray
•
MRI
What should the next step be?
•
Urgent senior evaluation for scrotal exploration
Management
•
Management will depend on the level of damage to the testicle seen
intraoperatively and would include either an
orchidectomy
or orchidopexy.
•
Additionally, the contralateral testis is also fixed to prevent torsion of
that side
Can you think of
any risk factors?
•
Boys aged 12-15
•
Bell clapper deformity
•
Undescended testes
Summary
•
Testicular torsion is a urological emergency which usually affects
young males but can occur at any age
•
It is caused by the twisting of the testicle on the spermatic cord which
compromises the vascular supply to the testes
•
If the history and examination suggests testicular torsion, an
immediate surgical exploration is required
•
Diagnostic investigations are not usually used in diagnosing testicular
torsion
•
Testicular torsion can lead to sub-fertility or infertility
Check image rights
•
Suppply a link to the page where the image is featured
•
Add reference section
Gain understanding of presentation and management of acute scrotal swelling in pediatric patients. Learn about testicular torsion, differentials, examination findings, and diagnostic investigations.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Acute Scrotal Swelling Anum Salam, Gillian Winter Created: February 2023 Tag year: Year 4 Tag speciality: Paediatric surgery Tag condition: Testicular torsion
Learning Aim To develop a greater understanding of the presentation and management of an acute scrotal swelling in the paediatric population
Presentation A 15-year-old boy is admitted to the emergency department with scrotal pain at 2:30pm. Mum reports he was well when he woke up this morning, but when he was outside playing football he suddenly started complaining about this pain.
1 2 3 List 8 differentials 4 5 6 7 8
What do you want to know about the pain? Site right side of scrotum Onset started suddenly and reached maximal intensity within a few minutes Character throbbing Radiation no Associated symptoms- felt nauseous and vomited twice, no urinary symptoms T- has been present since it started 2 hours ago E- nothing makes it better, moving makes it worse Severity- 9/10 This Photo by Unknown author is licensed under CC BY-SA-NC.
1 2 Narrow down to 5 differentials 3 4 5
Any other questions PMH- usually fit and well, normal pregnancy and birth, reached all his developmental milestones and up to date with immunizations Not on any regular medication, no previous admissions, no past surgeries, no allergies FH- nil noted SH- lives with his one brother and parent in a house, not sexually active
What would you like to do next? Testicular exam video: Testicular Examination - OSCE Guide - YouTube
What would you expect to find for each differential? testicular torsion (1,8,7) torted hydatid of Morgagni, (2,4,7,5,8,9) Epididymitis (3,6,7,5,9) 1 sudden pain 2 gradual pain 3 pain develops over a few days 4 blue spot 5 normal cremasteric reflex 6 Frequent and painful micturition 7 swelling of scrotum 8 Prehn's sign negative 9 normal testicular lie
Back to our child On examination you see a swollen, erythematous testicle that is high riding with a horizontal lie. Very tender to palpation. The cremasteric reflex is absent.
What is your top differential
Investigations Which investigation is routinely used to diagnose testicular torsion? Doppler ultrasound Urinalysis X-ray MRI
What should the next step be? Urgent senior evaluation for scrotal exploration
Management Management will depend on the level of damage to the testicle seen intraoperatively and would include either anorchidectomy or orchidopexy. Additionally, the contralateral testis is also fixed to prevent torsion of that side
Can you think of any risk factors? Boys aged 12-15 Bell clapper deformity Undescended testes
Summary Testicular torsion is a urological emergency which usually affects young males but can occur at any age It is caused by the twisting of the testicle on the spermatic cord which compromises the vascular supply to the testes If the history and examination suggests testicular torsion, an immediate surgical exploration is required Diagnostic investigations are not usually used in diagnosing testicular torsion Testicular torsion can lead to sub-fertility or infertility
Check image rights Suppply a link to the page where the image is featured Add reference section
