首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 96 毫秒
1.
Between July 1986 and March 2006, 102 patients underwent an operation for acute scrotum. Median age was 12.0 years old (range 0-51). Post-operative diagnosis revealed 50 cases (49%) of spermatic cord torsion, 29 cases (28%) of epididymal appendix torsion, and 13 cases (13%) of acute epididymitis. Spermatic cord torsion was most frequent in the age between 0 and 5, and 11 and 20, while epididymal appendix torsion was most frequent between 6 and 10. Moreover, acute epididymitis was most frequently seen in the age over 20. There were no apparent differences in the clinical symptoms such as scrotal pain, scrotal swelling, and abdominal pain. In the physical examinations, pyuria was the only finding to indicate acute epididymitis. In case of spermatic cord torsion, 'golden time' is defined as the time from onset to operation when testicular function can be expected for preservation. In this study golden time was defined as 8 hours because the testes was preserved in all 23 patients receiving the operation within 8 hours, but in only 10 (37%) out of 27 patients receiving the operation after 8 hours. Moreover, the operation within 24 hours saved the testes in approximately 90% of the patients. In patients with acute scrotum, emergency operation should be performed as speedily as possible for preservation of testicular function.  相似文献   

2.
Clinical review of acute scrotum in children]   总被引:3,自引:0,他引:3  
BACKGROUND: The acute scrotum in children frequently presents a diagnostic dilemma. The objective of this study is to review the experience of patients with acute scrotum in children. METHODS: From April 1986 until March 1998, we encountered 40 cases of acute scrotum in children less than 15 years old diagnosed by surgical exploration. RESULTS: Final diagnoses consisted of 14 patients with torsion of the spermatic cord (35%), 22 patients with torsion of the testicular appendage (55%), 3 patients with acute epididymitis (7.5%), and patient with a strangulated hernia (2.5%). Of 22 patients with torsion of the testicular appendage, which were the most frequent cause of acute scrotum, 20 had torsion of the testicular appendix and 2 had torsion of the epididymal appendix. The age distribution of the patients with torsion of the spermatic cord was biphasic, with the highest frequencies occurring in patients 2 years old and 14 years old. In contrast, the age distribution of patients with torsion of appendage showed a single peak incidence at 9 years of age. Those with epididymitis were younger than 2 years old. Of 14 cases of torsion of the spermatic cord, orchiectomy was performed in 6 cases (42.9%) because of testicular necrosis. CONCLUSION: Although surgical exploration is no longer necessary for all patients with torsion of the appendage, this review revealed that patients complaining of severe or persistent pain usually require surgery to diagnose and treat the problem.  相似文献   

3.
The list of differential diagnoses for the acute scrotum is extensive, but it is paramount to rule out torsion of the spermatic cord, most common in boys aged 13-17 years and the most common cause of acute scrotal pain and swelling up to 18 years old. Torsion requires emergency surgical exploration and detorsion if the testis is to be salvaged. The management of perinatal torsion is surrounded by some controversy and best dealt with by dedicated paediatric units. Beyond 18 years epididymitis is a more common finding, usually caused by chlamydial, gonococcal or coliform infection and investigations, antibiotic treatment and follow-up should be based on the 2010 national guidelines. Torsion of the appendix testis and appendix epididymis, remnants of the Mullerian and Wolffian ducts respectively, can mimic the more common diagnoses but most cases resolve spontaneously with non operative management. Torsion of the testis is more likely if the onset of pain is sudden, the pain is severe and the patient is younger than 20 years of age. When there is any doubt about the diagnosis, an emergency scrotal exploration should be undertaken.  相似文献   

4.
The list of differential diagnoses for the acute scrotum is extensive, but it is paramount to rule out torsion of the spermatic cord, most common in boys aged 13–17 years and the most common cause of acute scrotal pain and swelling up to 18 years old. Torsion requires emergency surgical exploration and detorsion if the testis is to be salvaged. The management of perinatal torsion is surrounded by some controversy and best dealt with by dedicated paediatric units. Beyond 18 years epididymitis is a more common finding, usually caused by chlamydial, gonococcal or coliform infection. Investigations, antibiotic treatment and follow up should be based on the 2010 national guidelines. Torsion of the appendix testis and appendix epididymis, remnants of the Mullerian and Wolffian ducts, respectively, can mimic the more common diagnoses but most cases resolve spontaneously with non-operative management. Torsion of the testis is more likely if the onset of pain is sudden, the pain is severe and the patient is younger than 20 years of age. When there is any doubt about the diagnosis, an emergency scrotal exploration should be undertaken.  相似文献   

5.
阴囊急症临床特点分析   总被引:7,自引:5,他引:7  
目的:探讨阴囊急症的鉴别诊断与治疗方法。方法:回顾性总结316例阴囊急症患者的临床特点,结合文献进行分析。结果:急性附睾炎117例(37.0%),急性睾丸炎76例(24.1%),急性鞘膜炎39例(12.3%),急性阴囊感染23例(7.3%),睾丸损伤21例(6.6%),特发性阴囊水肿17例(5.4%),睾丸扭转16例(5.1%),阴囊坏疽7例(2.2%)。手术治疗81例,非手术治疗235例。其中1例阴囊坏疽拒绝手术引流而死于中毒性休克。睾丸扭转患者Prehn's征均阳性,经手术治疗后恢复良好。结论:阴囊急症对男性健康危害较大,早期准确诊断十分重要,尽早采用针对性的处理措施是关键。  相似文献   

6.
Sixty-four patients with acute scrotal pain were examined by radionuclide scrotal scanning. We compared clinical, surgical and radionuclide findings. The scrotal scanning is a rapid, non invasive and painless examination with high accuracy in inflammatory disease. But two falsely negative scans in acute testicular torsion warn against this simple method. Torsion of the appendix testis were not recognized by scanning.  相似文献   

7.
The acute scrotum is a common referral to paediatric emergency departments. The term covers a wide range of diagnoses, with variable severity. The most time-sensitive diagnosis is testicular torsion, and this should be ruled out in all cases due to the risk of gonadal loss. History and examination may give some indication of the underlying cause of pain; however, surgical exploration of the scrotum is often required as an emergency procedure. This article describes the presentation, differential diagnosis and acute management of this common condition, as well as touching on some areas of debate.  相似文献   

8.
An account is given of results obtained from aggressive decisions taken to cope with acute scrotal pain. Thirteen in 121 patients received surgical treatment, although this would have been avoidable, since only epididymitis was eventually detected. That rate, however, had to be accepted due to inadequate reliability of the diagnostic methods so far available, even more so, when the following results are considered: The organ was saved in 39 cases. Pain was removed from 15 cases with pedunculated hydatid. Ten haematomas resulting from blunt testicular trauma were emptied. The surgical approach may be considered suitable for diagnosis, since complications are not to be expected, with the average time of the operation being limited to 18 minutes. The following guideline, therefore, should be observed in cases of post-traumatic, acute testicular pain: Diagnostic exposure is the optional method in cases of even slightest doubt in epididymitis. A sceptical attitude seems to be appropriate for all age groups, particularly when young patients are involved. Surgical exploration is a no-risk and fast approach and the only dependable method to save the organ.  相似文献   

9.
OBJECTIVE: To investigate children and adolescents who had scrotal exploration more than once. PATIENTS AND METHODS: Between 1994 and 2004, 64 of 840 (7.6%) boys had more than one scrotal exploration at our institution. The age, laterality of the explorations, the interval between and findings at operation, whether the testes were managed by orchidopexy and how, and the complications, were reviewed from the medical records and the operating reports of the patients. All the boys were followed at the outpatient clinic 2-4 weeks after surgery. RESULTS: The median (range) age of the patients was 11.5 (2-15) years; 61 had two scrotal explorations and three were explored three times. Of the patients, 32 presented with right testicular pain, 31 had left pain, and one had bilateral testicular pain. In the second exploration, 56 of 64 had the contralateral testis explored, five had an ipsilateral exploration and three had bilateral exploration. Forty-eight of the 64 boys (70%) had torsion of the contralateral appendix testis at the second exploration, and 5.3% (45/840) of the total number of children operated for acute scrotum had metachronous torsion of the appendix testis. The median interval between the first and second exploration was 8 months (1 day to 10.5 years). Two boys had three scrotal explorations, and three of 64 (4.7%) boys developed complications that required re-exploration. CONCLUSIONS: Most indications for recurrent scrotal exploration in this study are because of a twisted contralateral appendix testis, but the risk of developing this pathology is similar to the complication rate of repeat scrotal exploration. These data support our policy that the contralateral testis should not be routinely explored nor its appendix removed unless there is ipsilateral testicular torsion.  相似文献   

10.
11.
The term varicocele describes a dilated, tortuous and elongated pampiniform plexus of veins, which is well known in relation to the spermatic cord. Recently varicocele has also been observed inside the testis, and this new entity is known as intra-testicular varicocele. We present a case of intra-testicular varicocele presenting as acute scrotum and discuss the management issues.  相似文献   

12.
The management of acute scrotum can be challenging, especially in infants or patients with a neurological or neurodevelopmental disorder in whom presentation, diagnosis and definitive management tends to be delayed. This leads to poor outcomes, such as loss of the affected testis. Here we present two cases of testicular torsion in patients with neurodevelopmental disorders, and a further two cases of epidydimo‐orchitis in whom measurement of CD64 expression on neutrophils was helpful for differential diagnosis. These data suggest that the levels of expression of CD64 by neutrophils, known as a marker of infection, could also be useful for differentiating between testicular torsion and infection in acute scrotum.  相似文献   

13.
14.
15.
Amyand's hernia is a condition of exceptional presentation in children and is defined by the presence of inflamed appendix inside a inguinal hernia. It may manifest clinically as acute scrotum, inguinal lymphadenitis or strangulated hernia. The treatment is surgical and although several approaches are described, appendectomy with herniotomy by inguinal approach is considered of choice.  相似文献   

16.
17.
Background : The study investigates the hypothesis that testicular torsion is over‐diagnosed by emergency department (ED) doctors. Diagnoses made by ED doctors are compared with those made by a surgical registrar or specialist and the review outcome by a surgical registrar or specialist on diagnosis and management is evaluated. Methods : Medical records of all boys up to the age of 14 years who presented with an acute scrotum to the ED at The Canberra Hospital between October 1995 and October 2000 were retrospectively reviewed. Results : A total of 182 boys presented to the ED on 190 occasions; mean age of presentation was 10.1 years and mean time from onset of pain to presentation was 27.6 h. Ninety (47.4%) patients had a torted testicular appendage, 23 (12.1%) had testicular torsion and 12 (6.3%) had epididymitis or orchitis. Eighty‐one patients underwent surgery, in whom 61 were excluded from having testicular torsion. Testicular torsion was suspected by ED doctors in 57.5% of patients, by registrars in 35.4% and by specialists in 17.7%. Overall, the correct diagnosis was made by ED doctors in 39% of patients, by registrars in 53% and by specialists in 76%. Conclusions : Less experienced examiners suspect testicular torsion more frequently than surgical registrars or specialists. Review of the patient by an experienced examiner should allow for more accurate initial diagnoses and spare some children unnecessary surgical procedures.  相似文献   

18.
19.
20.
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号