The acute scrotum in childhood and adolescence.
BACKGROUND
The acute scrotum in childhood or adolescence is a medical emergency. Inadequate evaluation and delays in diagnosis and treatment can result in irreversible harm, up to and including loss of a testis. Various diseases can produce this clinical picture. The testis is ischemic in only about 20% of cases.


METHODS
This review is based on a selective literature search, the existing clinical guideline, and the authors' experience.


RESULTS
The clinical approach to the acute scrotum must begin with a standardized, rapidly performed diagnostic evaluation. Dopper ultrasonography currently plays a central role. Its main use is to demonstrate the central arterial blood supply and venous drainage of the testis. The resistance index of the testicular vessels should also be determined.


CONCLUSIONS
Physical examination and properly performed Doppler ultrasonography enable adequate evaluation of the acute scrotum in childhood and adolescence. In the rare cases of diagnostic uncertainty, immediate surgical exposure of the testis remains the treatment of choice.
Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. patrick.guenther@med.uni-heidelberg.de
Patrick
P
Günther
Iris
I
Rübben
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004823:Epididymitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012611:Scrotum / Q000098:blood supply* / Q000000981:diagnostic imaging*; D013086:Spermatic Cord Torsion / Q000150:complications* / Q000175:diagnosis* / Q000517:prevention & control; D014463:Ultrasonography