Cryptorchidism
Acute Scrotum Case Study
When a male presents with acute scrotum pain and swelling a number of different diagnoses are possible; however, if the diagnosis is testicular torsion then the patient needs to be evaluated by a competent surgeon immediately (reviewed by Kass and Lundack, 1997). Of the many possible diagnoses that can produce similar symptoms, including epididymitis, hernia/hydrocele, varicocele, epididymo-orchitis, torsion of a testicular or epididymal appendage (appendiceal torsion), or Henoch-Schonlein purpura, only testicular torsion represents a bona fide medical emergency. For this reason, a detailed patient history and physical examination should be undertaken at once in order to preserve testicular function. Every effort should be made to gather a complete urologic and surgical history for the patient to exclude other conditions, including a urinary tract infection and epididymitis.
A recent study examined the diagnosis distribution for 388 boys under the age of 17 who were treated at the Hospital for Children and Adolescents in Helsinki between 1977 and 1995 for acute scrotum (Makela, Lahdes-Vasama, Rajakorpi, and Wikstrom, 2007). Testicular torsion occurred in 26% of cases, while appendiceal torsion, epididymitis, and hernia occurred in 45%, 10%, and 8% of cases, respectively. The peak ages for testicular torsion occurred during the first year of life and adolescence (13 to 16 years). By comparison, the peak age for appendiceal torsion was between 9 and 12 years of age. Epididymitis preferentially occurred in infants under one year of age and was only rarely found on older boys and adolescents.
The case study considered here describes a 15-year-old boy presenting with a painful and red hemiscrotum containing a swollen descended testicle. Based on the findings of the Helsinki study (Makela, Lahdes-Vasama, Rajakorpi, and Wikstrom, 2007) the most likely diagnosis is testicular torsion given the boy's age, although he could still be suffering from several other conditions. The age of 15 is well within the adolescent peak range of 13 to...
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