Acute Scrotal Pain in Children
The common conditions that cause acute pain in the scrotum are:
- Torsion of the testis (twist of the testicle on its axis). This is more likely to occur during the adolescent period and around the time of puberty.
- Acute epididymitis (infection and inflammation of the tubes coming from the testicle. This happens either below the age of one year and between 12 -15 years.
- Twist of the appendage to the testis. This is the twist of small appendages from the testicle which are not serving any active function. In this situation children can present with swelling testis though the period of onset of the pain is slower when the compared to the torsion twist of the testicle itself.
How is testicular torsion diagnosed from other conditions?
The duration of symptoms in torsion is very short and about 70% of patients present within the first twelve hours compared to the other conditions mentioned previously. In torsion of the testis, the whole testicle can be very tender to touch and it is very unlikely that the child will allow one to examine the testicle. The testicle will also be swollen and very tender to touch. The position of the testicle would also look slightly abnormal due to the being pulled up because of the twist of the chord. In the other two conditions the position of the testicle is unlikely to be abnormal.
What is the treatment for torsion of the testis?
If torsion is suspected and could not be reliably ruled out by clinical examination, the treatment would be by an emergency exploration of the scrotum and untwisting of the testicle, if there is a twist. After untwisting the testicle, if it is still living, the testicle will be fixed in the scrotum at three points. If the torsion is confirmed on one side the other testicle will also be fixed because of the slightly higher risk of the other testicle going into torsion at a lager stage.