[Acute scrotum in childhood]. / Akutes Skrotum im Kindesalter.

BACKGROUND: Due to the variety of differential diagnoses causing acute scrotum and their possible consequences, this finding is a challenge for diagnostic and therapeutic management in the daily clinical practice of paediatric medicine. PATIENTS AND METHODS: Through a defined time period, all consecutive paediatric patients of a tertiary surgical centre aged up to 16 years who were diagnosed with and treated for primary acute scrotum were prospectively registered and retrospectively evaluated for patient, finding and treatment (intervention) associated specifics in this systematic unicentric observational study (design: case series) to reflect daily clinical practice. RESULTS: A total of 141 cases with acute scrotum were enrolled in the study during the 10-year period from January 2000 to December 2009. Eight percent of cases (n = 11) showed bilateral findings. There were two age peaks: newborns and puberty. The most common diagnoses were epididymitis and orchitis (26 %), torsion of the testicular appendix (22 %) and testicular torsion (21 %). Trauma, hydrocele, inguinal hernia, idiopathic scrotal oedema and tumours were rather rare differential diagnoses as possible causes for an acute scrotum. The mean period of discomfort, complaints and symptoms up to presenting in the outpatient clinic was 24 hours. For sixty percent (n = 84, i.e., all patients treated conservatively and 43 % of the operated patients) an imaging study was obtained with ultrasound or Doppler ultrasonography, respectively. Two thirds of the patients underwent an operative exploration. The orchiectomy rate in testicular torsion amounted to 40 %. In one newborn, a bilateral orchiectomy was necessary. In patients with unilateral orchiectomy, a prophylactic fixation of the contralateral testis was performed preferentially at 4-8 weeks after the initial intervention even though a simultaneous procedure is being increasingly used. CONCLUSIONS: In approximately one fifth of registered patients, a testicular torsion is present causing the acute scrotum, and leading to an obligatory surgical intervention. Various causative differential diagnoses can be clarified by precise medical history and exact physical examination. Imaging procedures can be helpful in decision-finding. Finally, the clinical finding is crucial and decisive. If a testicular torsion cannot reliably be excluded by clinical investigation or imaging, an immediate surgical exploration of the testis has to be performed.

[Bilateral intrauterine testicular torsion in a newborn]. / Bilaterale intrauterine Hodentorsion bei einem Neugeborenen.

Bilateral intrauterine testicular torsion is a rare condition associated with a low salvage rate of the testes. Due to variable symptoms it is difficult to rapidly find the correct diagnosis. Here, we report on a newborn with bilateral livid swelling of the scrotum for which a bilateral orchiectomy was carried out. Histological investigation of the specimens confirmed bilateral hemorrhagic infarction. The management of bilateral intrauterine testicular torsion is still controversial. Immediate surgical intervention is still considered to be the treatment approach of choice to salvage the testes.

[Incidental finding of an acute appendicitis in a premature newborn with haematochezia]. / Zufallsbefund einer akuten Appendizitis bei einem Frühgeborenen mit Hämatochezie.

In newborns, acute appendicitis is a very rare condition associated with significant lethality. Due to mostly non-specific symptoms, it is difficult to find the correct diagnosis preoperatively. Interestingly, rectal bleeding as a clinical sign in neonatal appendicitis is very uncommon. Here, we report on a 4-day-old premature female newborn with rectal bleeding who, therefore, underwent laparotomy because of a suspected volvulus. Except for an acutely inflamed appendix, no other pathological findings were found intraoperatively, leading to appendectomy. Histological investigation of the specimen confirmed acute ulcero-phlegmonous appendicitis. Thus, the rectal bleeding can be attributed to erosions as part of the inflammatory changes in clinically apparent appendicitis. The postoperative course of the patient was unremarkable, in perticular, no further rectal bleeding episode was observed. In spite of the low incidence of neonatal appendicitis, it has to be included in the spectrum of differential diagnoses if unclear abdominal discomfort occurs and whenever non-specific clinical signs are found in newborns. Early surgical intervention is considered the curative treatment approach of choice and can, thus, contribute to a reduction of the potential complications.