The acute scrotum in childhood

A review was made of 771 children with an acutely inflamed scrotum presenting during the 10 years 1976–1985. The relative incidence and age distribution of testicular torsion, torsion of an appendage, and epididymitis was compared. Epididymitis (13%) had a peak incidence in the first 2 years of life when urinary tract infections were common. The incidence of epididymitis was significantly lower than previously, and may reflect a changing pattern of disease. In addition, some patients with a diagnosis of epididymitis may have had infarction of a testicular appendage without haemorrhage. Torsion of a testicular appendage (58%) was most frequent at 11 years of age, 2 years before the maximum incidence of torsion of the testis (29%) at 13 years. This difference in timing may reflect a response by the cranial remnant of the müllerian duct to an increase in circulating oestrogens at the onset of puberty.