title: Critical analysis of the clinical presentation of acute scrotum: a 9-year experience at a single institution.
abstract: OBJECTIVE
  We assessed the significance of the clinical presentation of boys who underwent surgical exploration for acute scrotum.
  
  
  METHODS
  We retrospectively analyzed the records of 115 consecutive boys who underwent surgical exploration for acute scrotum between October 1986 and January 1996. We divided the children into group 1-83 with spermatic cord torsion a mean of 14.4 years old, group 2-27 with torsion of a testicular appendage a mean of 9.4 years old and group 3-5 with epididymo-orchitis a mean of 14.1 years old. Particular attention was given to nausea and vomiting, patient age and duration of pain.
  
  
  RESULTS
  Nausea and vomiting occurred in 69 and 60% of the boys in group 1, 8 and 4% in group 2 and none in group 3. Nausea and vomiting had positive predictive values of 96 and 98%, respectively, for spermatic cord torsion. Only 6 of the 83 boys (7%) with spermatic cord torsion were younger than 11 years, whereas 15 of the 27 (56%) with torsion of a testicular appendage were younger than 11 years. Of the 83 boys with spermatic cord torsion the testes were salvaged in 51 (61%) and the duration of pain was 40 minutes to 12 hours (mean 4 hours). The testes were not salvaged in any patient with greater than 12 hours of pain.
  
  
  CONCLUSIONS
  We believe that any boy 11 years old or older with scrotal pain less than 12 hours in duration that is associated with nausea or vomiting should be considered to have torsion of the spermatic cord. In this day of cost-effective medical management it is not necessary to perform imaging in this subset of boys before surgical exploration.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Children's Hospital 35233, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Jefferson
authors.forename: L M
authors.initials: LM
authors.lastname: Pérez
authors.forename: D B
authors.initials: DB
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000150:complications / Q000175:diagnosis* / Q000601:surgery