| Abstract | Objective: The aim of this study was to investigate demographic and clinical characteristics and outcomes of the treatments of the patients with an unusual presentation of the acute scrotum and to clarify their peculiarities.
Subjects and Methods: From January 1999 until December 2017, a number of 149 patients received an operation for TT in the pediatric surgery department of the University Hospital of Split. Out of that number, 25 patients were indentified with unusual presentation of an acute scrotum (14 patients who presented with an abdominal pain only, and 11 who presented with testicular torsion in inguinal canal). For each patient following parameters were investigated: age, symptoms, lateralization, degree of torsion, physical examination, outcomes of treatment, long-term consequences and complications.
Results: Eleven boys (7.38%) out of the total number of patients 149 (100%) turned out to have a testicular torsion within the inguinal canal and 14 (9.39%) children presented with abdominal pain only. The median age of all children with TT (n=149) at the moment of surgery was 14 years (range 0 days- 17 years). The duration of the symptoms varied substantially and ranged from 1 hour to 120 hours with a median of 6 hours, with only 63 (42.28%) out of the 149 patients staying below the golden 6 hours. Only 2/11 (18.18%) children of the inguinal group and 5/14 (35.71%) children of the abdominal group presented within 6 h. In the group with inguinal TT, the age distribution ranged from 0 to 16 years with a median age of 13 years. The symptoms were mostly abdominal pain (90.9%), followed by groin pain (45.45%), nausea (45.45%), scrotal edema (9.09%) and erythema (9.09%). In 6 out of 11 children, the first physical examination didn´t include a genital examination. The median duration of symptoms in the inguinal group was 24 h (range 3-60 h). In the group with abdominal pain, the age distribution ranged from 3 to 17 years with a median age of 13 years. The symptoms were limited, besides the abdominal pain, to groin pain (42.83%) and nausea (50%). In 9 out of 14 children, the first physical examination didn´t include a genital examination. The median duration of the symptoms in this group was 17 h (range 3-72 h). Orchidectomy was performed in the inguinal TT group in 54.54% and in the abdominal group in 57.14% of the cases.
Conclusion: Testicular torsion, particulary in regard to torsion in the inguinal canal or presenting dominantly with abdominal pain can be easily misdiagnosed, but needs to be recognized on time, to salvage the affected testicle. The complete physical examination, including the genital examination, needs to be performed in each male patient presenting with lower abdominal or groin pain. |
| Abstract (croatian) | Cilj istraživanja: Cilj ove studije je istražiti demografske i kliničke značajke, te ishode liječenja u bolesnika koji su liječeni zbog neuobičajene kliničke slike akutnog skrotuma i razjasniti njihove osobitosti.
Ispitanici i metode: Od siječnja 1999. do prosinca 2017. 149 bolesnika operirano je zbog torzije testisa u Klinici za dječju kirurgiju KBC-a Split. Od ukupnog broja bolesnika zabilježeno je 25 bolesnika koji su imali neuobičajenu kliničku sliku akutnog skrotuma (14 bolesnika koji su imali dominantno abdominalnu simptomatologiju i 11 bolesnika koji su imali torziju testisa u preponskom kanalu). Svakom bolesniku zabilježeni su slijedeće značajke: dob, simptomi, lateralizacija torzije, stupanj torzije, fizikalni nalaz, ishodi liječenja, praćenje i komplikacije.
Rezultati: Jedanaest dječaka (7,38%) od ukupno 149 imalo je torziju testisa u preponskom kanalu, a 14 (9,39%) ih je imalo torziju koja je bila praćena isključivo abdominalnom simptomatologijom, bez boli u testisu. Medijan dobi za svu djecu s torzijom testisa (n=149) u trenutku kirurškog zahvata iznosio je 14 godina (raspon 0 dana- 17 godina). Medijan trajanja simpoma iznosio je 6 sati (raspon 1-120 sati). Samo 63 (42,28%) bolesnika došla su unutar tzv. zlatnog perioda od 6 sati. Samo 2/11 (18,18%) djece u grupi torzija u preponskom kanalu i 5/14 (35,71%) djece s abdominalnom simptomatologijom javilo se unutar 6 h od početka simptoma. U grupi torzija u preponskom kanalu medijan dobi iznosio je 13 godina (raspon 0-16 godina). Najčešći simptom bio je bol u trbuhu (90,9%), a slijedili su ga bol u preponi (45,45%), mučnina (45,45%), otok skrotuma (9,09%) i crvenilo (9,09%). U 6 od 11 dječaka prvi pregled nije uključivao pregled genitalne regije. Medijan trajanja simptoma u ovoj grupi bio je 24 h (raspon 3-60 h). U grupi torzija s predominantno abdominalnom simptomatologijom medijan dobi iznosio je 13 godina (raspon 3-17 godina). Bol u trbuhu bila je dominantni simptom u svih bolesnika u ovoj grupi, a slijede je bol u preponi (42,8%) i mučnina (50%). U 9 od 14 dječaka prvi pregled nije uključivao pregled genitalne regije. Medijan trajanja simptoma u ovoj skupini bio je 17 sati (raspon 3-72 sati). U skupini bolesnika s torzijom testisa u preponskom kanalu orhidektomija je učinjena u 54,54% dječaka, a u skupini torzija s predominantno abdominalnom simptomatologijom čak u 57,14% dječaka.
Zaključak: Torzija testisa, osobito ako nema uobičajenu simptomatologiu i prezentira se kao torzija u preponskom kanalu ili dominantno abdominalnom simptomatologijom lako može biti previđena, iako bi trebala biti prepoznata na vrijeme da bi se testis sačuvao. Kompletan fizikalni pregled, uključujući pregled genitalne regije treba biti sastavni dio svakog pregleda u dječaka i adolescenata koji se žale na bol u trbuhu ili preponi. |
