Surgical management of the acute paediatric scrotum: a three-year single centre experience.

BACKGROUND: Acute scrotal pain is a common emergency presentation in paediatric surgery. Torsion of the testicular appendage (TTA) is the most common cause for pain, with testicular torsion (TT) being the sinister pathology to exclude. Outcomes are time dependent, and a delayed scrotal exploration could result in testicular loss. METHODS: We performed a review on a large retrospective cohort of 449 surgical scrotal explorations at a large referral paediatric surgical centre over three years. RESULTS: Only about a quarter of children with testicular pain presented within 4 h. TT is commonly associated with nausea and an abnormal lie. Two children with a classical 'blue dot' sign were later found to have a testicular torsion. 19% of all children with a TTA were also seen to have Bell clapper anomaly (BCA). Recurrent testicular pain was associated with 84.7% (p < 0.001) of BCA. Intra-operative diagnosis of TTA correlated with histopathology in 84.6% (p=0.021). The sensitivity of intraoperative diagnosis was 90.9% with a specificity of 75.3%. CONCLUSION: Routine histopathology for a classic TTA may not be required especially in resource poor situations. All children presenting with recurrent episodes of testicular pain must be considered for surgical scrotal exploration. And in view of the incidence of BCA in this cohort, all scrotal explorations for acute scrotal pain should include an assessment for BCA.

Minimally invasive surgical treatment of pilomatrixoma.

BACKGROUND: Pilomatrixoma is a benign skin tumour often presenting as a firm irregular mass in the paediatric population. The most common site is on the head and neck. Traditionally, a wide local excision has been the method of management. We propose an incision and curettage (I&C) technique for an improved cosmetic outcome. METHODS: A retrospective review of children who underwent I&C for pilomatrixoma was done between January 2010 and June 2020. The I&C technique involved making a small incision over or near the lesion in a discrete location such as behind the hairline and removing the tumour piecemeal. Four to six weeks of routine post-operative follow-up was conducted. Patients and families were also subsequently contacted via a survey to assess for late recurrence, any other complications and ascertain their level of satisfaction with the outcome. RESULTS: Twenty lesions were removed in 11 patients over this time with a female predominance (seven) and most lesions were on the face (11). No patients had a recurrence in a mean follow-up time of 6 years (1-10 years). All parents are very satisfied with the cosmetic result. CONCLUSION: I&C may be an effective and cosmetically pleasing method to removing pilomatrixoma.