Clinical Case Database / Category: Patient Management

Acute scrotal pain and swelling in paediatric and adolescent patients: diagnosis and management

Publication details

Dr Laura Rachel Blake, Miss Jennifer Billington, Dr Rim El-Rifai, Mr Mohammed Y Hammadeh
Foundation Years Journal, volume 8, issue 10, p.10 (123Doc Education, London, November 2014)

Abstract

Doctors working in the Emergency Department will encounter cases of children and adolescents presenting with acute scrotal pain and swelling. This discussion focuses on the three most common primary causes. An informed clinical diagnosis relies on the history, physical examination, and appropriate investigations. The most serious cause of acute scrotal pain and swelling is spermatic cord torsion (SCT). Urgent scrotal exploration, within 6 hours of the onset of pain, is required to salvage the testis before irreversible testicular necrosis occurs. The other two common causes of acute scrotal pain and swelling are testicular appendage (hydatid of Morgagni) torsion and epididymo-orchitis. These can be safely managed with conservative and medical treatment respectively. Doctors should be mindful that there is a wide differential diagnosis for scrotal pain and swelling which falls beyond the remit of this discussion. In this discussion, spermatic cord torsion implies intravaginal spermatic cord torsion, and omits discussion of extravaginal spermatic cord torsion which classically affects the perinatal population.

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Authors

Dr Laura Rachel Blake

Foundation Year 1 Doctor, Queen Elizabeth Hospital
Stadium Road, London, SE18 4QH
laurablake@nhs.net

Miss Jennifer Billington

Core Surgical Trainee, Queen Elizabeth Hospital
Stadium Road, London, SE18 4QH
jenniferbillington@rcsi.ie

Dr Rim El-Rifai

Consultant Paediatrician and Honorary Senior Lecturer
Queen Mary's Hospital for Children
Epsom & St. Helier University Hospitals NHS trust, KT187EG
relrifai@aol.com

Mr Mohammed Y Hammadeh (Corresponding author)

Consultant Urological Surgeon and Honorary Senior Lecturer
Foundation Trianing Programme Director
Queen Elizabeth Hospital, Stadium Road, London, SE18 4QH
myhammadeh@aol.com

References

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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