title: Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients.
abstract: BACKGROUND
  The aim of this study was to analyze management and outcomes of treatment in patients with acute scrotum.
  
  
  METHODS
  From January 1990 until January 2015 case records of 558 patients who underwent surgery for acute scrotum were retrospectively reviewed. Mean age was 12 years old. Each patient was analyzed for following parameters: history data, localization of pain, physical examination, operating results and the results of follow up, age, etiology, and the time from initial symptoms to surgery.
  
  
  RESULTS
  Scrotal explorations revealed 142 cases (25%) of spermatic cord torsion, 344 (62%) torsion of the testicular appendage, 54 (10%) epididymitis, 10 (2%) testicular trauma and 8 cases (1%) of other conditions. Two peaks of incidence of spermatic cord torsion were found, the first during first year of life and the second between 13 and 15 years of life. In patients with spermatic cord torsion, median duration of symptoms in the group of salvaged testes was 6 hours; while in the group of patients who underwent orchiectomy was 46 hours. Of the total number of patients with spermatic cord torsion 40 patients (28%) underwent orchiectomy while 102 testicles (72%) were saved. There were no major complications. Acute scrotum is significantly more common in the winter. Torsion of the testis has the highest incidence in January and August.
  
  
  CONCLUSIONS
  Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. It is of great importance that the patient seeks immediate medical attention. If the patient arrived within 6 hours the testicle can be saved.
authors.affiliation: Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Split, Croatia.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Pogorelić
authors.forename: Krešimir
authors.initials: K
authors.lastname: Mustapić
authors.forename: Miro
authors.initials: M
authors.lastname: Jukić
authors.forename: Jakov
authors.initials: J
authors.lastname: Todorić
authors.forename: Ivana
authors.initials: I
authors.lastname: Mrklić
authors.forename: Jakov
authors.initials: J
authors.lastname: Mešštrović
authors.forename: Ivo
authors.initials: I
authors.lastname: Jurić
authors.forename: Dubravko
authors.initials: D
authors.lastname: Furlan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D017523:Croatia / Q000453:epidemiology; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D004823:Epididymitis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D059351:Organ Sparing Treatments / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012611:Scrotum / Q000503:physiopathology*; D012621:Seasons; D013086:Spermatic Cord Torsion / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D063189:Symptom Assessment / Q000379:methods; D013737:Testis / Q000293:injuries / Q000601:surgery; D013997:Time Factors