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1.
Cavusoglu YH Karaman A Karaman I Erdogan D Aslan MK Varlikli O Cakmak O 《Indian journal of pediatrics》2005,72(3):201-203
Objective: Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation
can confidently exclude torsion of testis from the differential diagnosis.Methods: A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983
and March 2003 was performed.Results: 195 boys were included in this study. They were divided into 3 groups: group 1–73 with epididymo-orchitis, group 2–63 with
torsion of testicular appendages and group 3–57 with spermatic cord torsion. The patients in group 2 were older than group
1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion,
whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was
2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common
entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was
37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups.Conclusion: We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be
applied routine surgical exploration. 相似文献
2.
Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis 总被引:5,自引:0,他引:5
BACKGROUND: Although the primary abnormality in testicular torsion is at the spermatic cord, imaging studies up to now have mostly been oriented to evaluation of the testicle itself, with emphasis on color Doppler ultrasonography (US). However, findings can be inaccurate when there is incomplete interruption of testicular flow. Indirect findings, such as morphological changes in the testis alone, are not reliable for the diagnosis since they become evident late in the disease. OBJECTIVE: To call to attention to the fact that sonographic visualization of the spermatic cord can be the key for diagnosis in those patients with acute scrotal pain as a result of testicular torsion, particularly when color Doppler US shows that intratesticular flow is present within the affected testis. PATIENTS AND METHODS: Six patients who presented clinically with acute scrotal pain and had spermatic cord torsion, proven at surgery. All patients were initially studied with color Doppler US, and intratesticular flow was detected in all of them. Patients who showed structural abnormalities on gray-scale US and/or absence of intratesticular vascular flow in the affected testis were not included. In addition to a conventional study, the spermatic cord was examined. RESULTS: The spermatic cord was shown to be rotated on the symptomatic side in all patients. Local morphological and vascular flow changes, distal and at the site of the torsion, were found and registered. CONCLUSIONS: The finding of a rotated spermatic cord could be a highly reliable and direct sign for the diagnosis of a testicular torsion, and this is especially important when vascular flow is present within the affected testis on color Doppler US examination. Examination of the spermatic cord should be added to evaluation of the testis in patients with suspected testicular torsion to enhance sensitivity of the examination. 相似文献
3.
Ioannis D. Lyronis Nikoloas Ploumis Ioannis Vlahakis Giorgos Charissis 《Indian journal of pediatrics》2009,76(4):407-410
Objective The aim of the present study was to evaluate the etiology, history, physical examination findings, and seasonal variation
of acute scrotal problems in children.
Methods A retrospective review of all boys, presenting with acute scrotum to the Pediatric Surgery Clinic of the University Hospital
Heraklion between January 1989 and December 2006 was performed.
Results A total of 140 boys presented with scrotal pain were included. Overall the commonest cause of acute scrotum was epididymo-orchitis
(35%, 95%CI: 27%–43%), followed by torsion of appendages. In contrast the most common cause in boys of preschool age was spermatic
cord torsion (P<0.020). All cases of spermatic cord torsion were characterized by severe testicular pain and an absent cremasteric
reflex. The interval between pain initiation and presentation to our clinic was 11.4 hours (SD:3.07) when the testis was salvaged
by detorsion, and 19.0 hours (SD:6.32) when the testis was removed. The difference between means was statistical significant
(p<0.001). The incidence of torsion of appendages (p<0.036) and/or spermatic cord (p<0.047) was increased in winter.
Conclusion The absence of cremasteric reflex in association with testicular tenderness strongly suggests testicular torsion. The low
temperatures during winter may account for the increased incidence of the torsion of both the spermatic cord torsion and the
appendages. 相似文献
4.
Background. Colour Doppler sonography (CDS) has become the procedure of choice in evaluating testicular perfusion but false negative
findings have been reported. Objective. To determine if direct visualisation of the twisted spermatic cord using high resolution US is a reliable sign to assess
testicular torsion. Material and methods. Thirty patients (aged 2–26 years) with equivocal diagnosis of testicular torsion prospectively underwent high resolution
and CDS. The results were correlated with surgical findings. Serial transverse and longitudinal scans were performed to compare
the scrotal contents on each side and study the complete spermatic cord course, from inguinal canal to testis, to detect a
spiral twist. Results. In 14 of the 23 cases of torsion, the diagnosis was based on the colour Doppler findings in the scrotum because blood flow
was absent in the symptomatic testis and detectable without difficulty on the normal side. In nine cases, CDS was unreliable;
in six cases intratesticular perfusion was present in a twisted testis and in three small boys, no colour signal was obtained
in either testis. In all cases of torsion, the spiral twist of spermatic cord was detected at the external inguinal ring.
The twist induced an abrupt change in spermatic cord course, size and shape below the point of torsion. It appeared in the
scrotum as a round or oval, homogeneous or heterogeneous extratesticular mass with or without blood flow, that could be connected
cephalad with the normal inguinal cord. In the other seven cases (three late torsions of the appendix testis, one epididymo-orchitis
and three torsions with spontaneous reduction), no spiral twist was detectable. Conclusion. The detection of spermatic cord spiral twist appears a reliable US sign of torsion whatever the testicular consequences.
Received: 1 December 1997 Accepted: 17 June 1998 相似文献
5.
Maas C Müller-Hansen I Flechsig H Poets CF 《Archives of disease in childhood. Fetal and neonatal edition》2011,96(2):F149-F150
The authors report on a rare case of neonatal scrotal oedema occurring concurrently with pain upon palpation of the spermatic cord on the first day of life. An ultrasound examination showed poor perfusion of the left testicle and a thrombosis of the left renal vein; intraoperative exploration indicated necrosis of the left testicle without signs of torsion. Gorged vessels with paravasal bleeding were found in the spermatic cord. The authors hypothesise that necrosis of the testicle may result from haemorrhagic infarction caused by renal venous thrombosis. Acute scrotal discolouration with pain upon palpation in neonates is usually attributed to testicular torsion. The authors report a case where these symptoms had a different cause. 相似文献
6.
K. W. LIU K. W. KU K. L. CHEUNG Y. L. CHAN 《Journal of paediatrics and child health》1994,30(4):368-369
Two neonates presented with acute scrotal swelling suggestive of testicular torsion. Surgical exploration in one patient revealed an infected haematoma. Subsequent investigations including ultrasonography and urinary catecholamine determination disclosed adrenal haemorrhage as the cause of the scrotal haematoma. A second patient in whom a purplish discolouration of the right hemiscrotum was noted was also investigated with ultrasonography, which revealed a normal right testis and a right adrenal haematoma. Both cases of adrenal haemorrhage resolved spontaneously on conservative treatment. Adrenal haemorrhage should be considered as a possible cause of acute scrotal swelling in neonates. Ultrasonography assessment should be performed in such cases to examine the intra-abdominal organs especially the adrenal glands. 相似文献
7.
新生儿睾丸扭转临床特点探讨 总被引:1,自引:0,他引:1
目的 探讨新生儿睾丸扭转发生的特点及治疗时机选择.方法 回顾性分析近10年新生儿睾丸扭转患儿可能的致病危险因素、临床特点、超声检查结果、治疗策略、病理结果及术后随访情况.结果 新生儿睾丸扭转共17例,左侧7例,右侧10例;其中剖腹产11例(65%),第二产程延长5例(29%),羊水过少2例(12%);术前体检均发现睾丸增大,多伴有阴囊色泽改变(94%).超声检查均发现患睾体积增大、回声不均或增强、血流信号减小或消失.术中探查打开肉膜组织后均发现精索睾丸扭转并已坏死而行患睾切除,其中14例行对侧睾丸固定术.所有患睾病理活检均提示睾丸坏死,7例(41%)可见钙化灶.所有随诊病例超声检查未发现对侧睾丸异常.结论 新生儿睾丸扭转失睾率极高;当发现阴囊色泽改变、睾丸增大等改变,即应考虑睾丸扭转可能;超声检查敏感性高,可作为首选检查方法;患儿出生过程出现异常可能是新生儿睾丸扭转的诱因.Abstract: Objective To investigate the clinical characteristics and management of neonatal testicular torsion. Methods Neonatal testicular torsion were reviewed focusing on the possible risk factors, clinical features, ultrasonic characteristics, management, pathological outcome and follow-up results. Results A total of 17 neonatal testicular torsion (left side 7, right side 10) was diagnosed. 11cases of them were cesarean delivery (65 %). 5 cases were found a prolonged second stage of labor (29%), and 2 cases with oligohydramnios (12%) before birth. All patients presented an enlarged testes. Most of them presented with scrotal discoloration (94%). Ultrasound examination showed enlargment of testicular volum, heterogeneity and lacked of blood flow. The twisted testes and spermatic cord showed necrosis intra-operatively. Orchiectomy was carried out. Orchidopexy on contralateral testis was performed in 14 cases. Pathology of ipsilateral testes showed necrosis, and calcification occurred in 7 cases(41 %). All contralateral testes presented normal Ultrasound image during the followup. Conclusions The rate of testicular necreosis was high in neonatal testicular torsion. Testicular torsion should be suspected when neonatal testis presents scrotal discoloration and enlarged testicular mass. Ultrasound inspection is a sensitive method in diagnosing neonatal testis torsion, and should be recommended. Abnormal labor may lead to the neonatal testis torsion. 相似文献
8.
The acute scrotum is one of the commonest surgical emergencies in pediatric practice. Early diagnosis, prompt treatment, and
preventive measures are important to avoid testicular infarction. Occurrence of torsion has been previously reported following
orchidopexy for undescended testis and for previous torsion of the testis. We report a case of intravaginal torsion of the
testis in a patient who had previously undergone exploration and excision of a torted hydatid of Morgagni without formal orchidopexy.
As exploration of the scrotum does not confer protection against subsequent torsion, orchidopexy should be routinely performed
in patients who are found to have high investment of the tunica vaginalis or separation of the epididymis and testis on scrotal
exploration for any reason.
Correspondence to: E. J. Guiney 相似文献
9.
Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum 总被引:4,自引:0,他引:4
The acute scrotum in the paediatric population is a clinical dilemma where a definitive diagnosis can only truly be made at surgical exploration. We postulate that surgical exploration in all cases allows truly accurate diagnoses, treats the torted appendage testes and enables the validity of clinical signs associated with scrotal pathology to be assessed. We retrospectively reviewed all boys less than 15 years old who presented to our institution with scrotal pain over a 2 year period. A total of 121 patients attended of whom 113 had exploratory surgery, 31 (27%) had testicular torsion, 64 (57%) had a torted appendage testis, 12 (11%) had epididymitis, 1 (1%) had fat necrosis and 5 (4%) had no abnormality detected. On exploration 9 (29%) of the torted testis were unsalvageable and thus required excision. The initial clinical impression was frequently demonstrated to be flawed. Two patients with testicular torsion presented with a painless swelling and two further patients had necrotic testes despite a history of pain for less than 4 h. A normal cremasteric reflex and a visible blue dot were detected in boys with testicular torsion. Doppler ultrasound scans were not reliable with 50% sensitivity to clearly differentiate between torsion of the testis and that of the appendage testis. Absolute dependence on clinical features can lead to a misdiagnosis of testicular torsion. The surgical treatment of torted appendage testis is safe, allowing accurate diagnosis and pain relief with minimal morbidity. Early scrotal exploration of all cases with testicular pain ensures maximal testicular salvage. 相似文献
10.
B. Klin L. Zlotkevich T. Horne G. Livshitz Y. Efrati I. Vinograd 《Pediatric surgery international》1996,11(7):483-486
To determine a reliable clinical approach to the problem of acute scrotum (AS) in children and identify patients who require emergent surgical intervention, 65 boys with the diagnosis of AS were studied. The mean age was 11 years. Acute orchitis/epididymitis was diagnosed in 42 (64.6%), torsion of the testis in 12 (18.5%), and torsion of the appendix testis in 5 (7.7%). A testicular radionuclide scan was the most reliable diagnostic tool, being positive in all 12 cases of torsion of the testis. Eighteen patients underwent scrotal exploration. Detorsion and bilateral orchidopexy was performed in 12, excision of a necrotic appendix testis in 5, and evacuation of a scrotal hematoma in 1. The outcome of the involved testis at follow-up examination was excellent, with only 1 child developing testicular atrophy. This study stresses the reliability of the selective approach for the treatment of the AS in children. 相似文献
11.
《Journal of pediatric urology》2013,9(5):542-545
ObjectiveThe evaluation and treatment of perinatal testicular torsion is controversial. We performed a survey to assess practice patterns among pediatric urologists regarding treatment of perinatal torsion.MethodsAn internet survey was administered to members of two pediatric urology societies. Cases of prenatal, postnatal and bilateral prenatal torsion were outlined. Respondents were asked about use of ultrasound, timing of surgery, incision, and management of the contralateral testicle. A case with a non-palpable testicle and blind ending vessels was also presented.ResultsWe had 121 respondents. In a neonate with prenatal torsion, 34% percent would operate immediately, 26% urgently within 72 h, 28% electively and 12% would not explore; 93% would perform a contralateral orchiopexy. In a neonate with postnatal torsion, 93% would operate immediately, 5% urgently, 1% electively and 1% would not explore; 96% would perform a contralateral orchiopexy. In both cases, 75% would use a scrotal incision and 25% would use an inguinal incision. When presented with bilateral prenatal torsion, 90% would operate immediately, 1% urgently, 2% electively and 7% would not operate. In the case of a non-palpable testicle with blind ending vessels 28% would perform a contralateral orchiopexy, 12% would explore the ipsilateral canal for a “nubbin”, 56% would perform no intervention and 4% would perform some other form of management.ConclusionWe documented variability of timing for intervention of prenatal torsion and confirmed that most view postnatal torsion as a surgical emergency. Most perform a contralateral orchiopexy for prenatal torsion despite the fact that most cases are extravaginal. The surgical approach via a scrotal incision appears to be preferred at this time. 相似文献
12.
Breysem L Herman M Moerman P Van Damme-Lombaerts R Bogaert G Smet M 《Pediatric radiology》2006,36(11):1186-1189
Scrotal abscess in infancy is rare and, in an otherwise healthy infant, an unexpected pathology. We present a 2-week-old boy
with a unilateral scrotal swelling, imaged by high-resolution sonography. Sonography with colour Doppler demonstrated an encapsulated
heterogeneous mass in the left scrotum with surrounding hyperaemia and a hypervascular spermatic cord. The testis was not
demonstrable with full certainty and surgical exploration was undertaken. A scrotal abscess, indistinguishable from the testis
and epididymis, had to be resected and on histology was found to have originated from the tunica vaginalis. Urogenital investigations
did not reveal any associated abnormality and the final diagnosis was idiopathic scrotal abscess. High-resolution sonographic
features with colour Doppler of a scrotal swelling can suggest an abscess and help determine appropriate therapy. 相似文献
13.
Cheri Mathews John Gagan Kooner Deepa E Mathew Shiban Ahmed Simon E Kenny 《Acta paediatrica (Oslo, Norway : 1992)》2008,97(4):502-504
Twenty-four neonates presented with signs of testicular ischaemia over a 13-year period. They had a mean birth weight of 3.706 kg. The right testicle was affected in 13, the left in 9 and there was bilateral torsion in 2 babies. Two babies had no twist in the cord, but the testicles were nonviable macroscopically and microscopically. Twenty-one babies had primary exploration revealing necrotic testes in all patients and they underwent orchidectomies. The other three babies had conservative management and the affected testes had atrophied on follow-up. Sixteen babies had contralateral orchidopexy. Doppler ultrasound scans were reported as normal in 2 of 13 babies who had scans. No testes were salvaged following surgery.
Conclusion: The incidence of testicular torsion in the neonatal period was calculated as 6.1 per 100 000 live births. No testis was salvaged following surgery in our series of 24 patients. This dismal outcome underlines that immediate surgical exploration, although commonly performed, rarely saves torted testes. 相似文献
Conclusion: The incidence of testicular torsion in the neonatal period was calculated as 6.1 per 100 000 live births. No testis was salvaged following surgery in our series of 24 patients. This dismal outcome underlines that immediate surgical exploration, although commonly performed, rarely saves torted testes. 相似文献
14.
Cheri Mathews John Gagan Kooner Deepa E Mathew Shiban Ahmed Simon E Kenny 《Acta paediatrica (Oslo, Norway : 1992)》2008,97(4):502-504
Twenty-four neonates presented with signs of testicular ischaemia over a 13-year period. They had a mean birth weight of 3.706 kg. The right testicle was affected in 13, the left in 9 and there was bilateral torsion in 2 babies. Two babies had no twist in the cord, but the testicles were nonviable macroscopically and microscopically. Twenty-one babies had primary exploration revealing necrotic testes in all patients and they underwent orchidectomies. The other three babies had conservative management and the affected testes had atrophied on follow-up. Sixteen babies had contralateral orchidopexy. Doppler ultrasound scans were reported as normal in 2 of 13 babies who had scans. No testes were salvaged following surgery. CONCLUSION: The incidence of testicular torsion in the neonatal period was calculated as 6.1 per 100,000 live births. No testis was salvaged following surgery in our series of 24 patients. This dismal outcome underlines that immediate surgical exploration, although commonly performed, rarely saves torted testes. 相似文献
15.
Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. Acute and intermittent sharp testicular pain and scrotal swelling, interspersed with long intervals without symptoms, are characteristic. Physical findings may include horizontal or very mobile testes, an anteriorly located epididymis, or bulkiness of the spermatic cord from partial twisting. Awareness of this entity and early elective orchiopexy will improve testicular salvage in patients with intermittent testicular torsion. 相似文献
16.
Neonatal adrenal hemorrhage may rarely present as scrotal hematoma. This condition can simulate a torsion of the testis requiring an immediate surgical exploration of the scrotum. Ultrasonographic study of the abdomen can find out intraperitoneal or retroperitoneal bleeding in order to avoid unnecessary surgical intervention. The case of a newborn with right adrenal hemorrhage presenting as left scrotal hematoma is reported. 相似文献
17.
Classically, testicular torsion occurs in neonates or during puberty. Between these two ages, is it really an exception? METHOD AND PATIENTS: In order to answer the question, we reviewed the charts of the patients referred to the department of pediatric surgery of Bicêtre hospital between 1992 and 2001. We studied the preoperative examinations, the operative data and the long term evolution. Cases of torsion occurring during neonatal or pubertal periods were excluded. RESULTS: During nine years, 86 patients with "acute scrotum symptoms" underwent surgery. The ages of patients ranged from one month to 11 years (average age: five years) in 26 patients, among which 12 had true testicular torsion. Consultation at the emergency room occurred after one to 72 hours (average of 17). The localization of the pain was on the left in eight cases and on ectopic testicle in two. The testicular volume was increased in 11 cases. Cremasteric reflex was absent in four cases. The doppler flow was normal in four cases and absent in four. During surgery, the testis appearance was considered as normal in six testicles, as necrotized in three (and an orchidectomy was performed) and as ischemic in three. In seven cases, a peroperative contralateral testicle fixation was performed and later one in two. The postoperative course was simple, without infection and with a normal testicular volume in eight cases, increased in one ischemic testis. Testicular atrophy was noted in an ischemic testis, after several months. CONCLUSION: Whatever the age, testicular torsion remains a surgical emergency even with a normal doppler flow. 相似文献
18.
R.I. Kylat 《Archives de pédiatrie》2021,28(1):75-79
Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue ischemia. If this occurs in the first month of life it is referred to as “perinatal TT” (PTT) or “neonatal TT” (NTT). PTT has an incidence of 6.1 per 100,000 live births. Some of these cases occur prenatally. It can be missed on the initial newborn examination, as it can be asymptomatic. Hence, the true incidence is much higher since it is underdiagnosed. The types of TT include extravaginal, intravaginal, and mesorchial. Most cases of PTT are extravaginal. The diagnosis can generally be made on physical examination. Ultrasonography (US) can help exclude other rare diagnoses as long as surgical intervention is not delayed. There has been some debate regarding the timing of surgery. Although the torsed testicle may not be salvageable, the likelihood of asymptomatic bilateral TT has to be borne in mind and contralateral orchiopexy done at the time of exploration would prevent an asynchronous torsion. Nonoperative maneuvers to detorse in PTT are not recommended. The evaluation, diagnostic approach, and management of this relatively rare condition are described. 相似文献
19.
To distinguish spermatic cord torsion from other intrascrotal pathology, scrotal ultrasound and radionuclide scanning have been highly recommended on the basis of both clinical and experimental studies. We review the data from six patients in whom ultrasound or nuclear medicine examination was misleading. We emphasize that history, physical examination, and urinalysis remain the cornerstones of the diagnosis of spermatic cord torsion. Scrotal ultrasound and nuclear medicine scans are useful adjuncts and are reassuring when in agreement with the clinical picture. However, they are not 100% sensitive or specific, and a negative study should not prevent emergency operative exploration of a clinically suspicious lesion. 相似文献
20.
B. Tander K. Sarica D. Baskin L. Abbasoğlu D. Sakiz M. Bulut 《Pediatric surgery international》1998,14(1-2):14-16
Unilateral torsion of the spermatic cord has been demonstrated to damage the contralateral testis; however, the pathogenesis
has not yet been examined in detail. The purpose of this study was to evaluate the influence of unilateral torsion on the
contralateral testis in rats by performing ipsilateral division of the genitofemoral nerve (GFN) and/or late orchiectomy.
Male 25-day-old, prepubertal Wistar albino rats were divided into five groups: (1) sham operation; (2) unilateral testicular
torsion; (3) simultaneous unilateral testicular torsion and ipsilateral GFN division; (4) unilateral testicular torsion and
orchiectomy on the 4th day after torsion; and (5) simultaneous unilateral testicular torsion and GFN ipsilateral division,
and orchiectomy on the 4th day after torsion. Torsions performed were 720°, all on the right testes. On day 55 after torsion,
which represents the early postpubertal period of the rat, the contralateral testes were removed. Tubular biopsy score (TBS)
was calculated, and seminiferous tubular diameters (STD) were measured. Student's t-test was used for statistical analysis. There was no contralateral testicular damage in the control group, but in all of
the study groups destructive changes were found in the left gonad after torsion of the right testicle. The mean TBS of the
study groups was higher than that of the control group. STD values were lower in the study groups, but the differences were
not statistically significant between groups. In prepubertal rats, unilateral torsion causes histologically measurable changes
in the contralateral testis. Ipsilateral division of the GFN and late orchiectomy did not cause any significant alterations
in terms of contralateral damage. Further investigations are needed to determine the role of the GFN in testicular torsion. 相似文献