The acute scrotum is a medical emergency, and the objective is to prevent possible damage to the testicular parenchyma. Doppler ultrasonography has the central role in this setting. In order to correctly assess perfusion of a testicle in children, experience in this setting is indispensable, in addition to the criteria listed in our article. If the initial examiner does not have the relevant expertise the patient should immediately be referred to where the examination and possibly required surgical intervention can be performed adequately. No relevant delay is acceptable. The relevant sentence in our conclusion—“Whenever doubt exists, it is safer to explore”—therefore remains the guiding principle in the treatment of the acute scrotum (1).
It is indisputable that the general physical condition should be assessed in children with abdominal or inguinal pain. This includes the scrotum in boys, since the pain caused by the acute scrotum can radiate into the abdomen. Because the topic is enormously wide-ranging we did not mention the differential diagnoses of abdominal pain in children in our review of the acute scrotum.
As mentioned in the letter by Santos und Kohl and in our review article, laboratory chemistry does not have any role in the differential diagnostic evaluation (2). This should be considered only in settings where leukemia is sufficiently strongly suspected. We thank our correspondents for pointing out that ipsilateral torsion is possible even after testicular fixation (3). Several surgical methods for fixating the testes after torsion have been presented in the literature.
Dr. med. Patrick Günther
Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und
Transplantations-chirurgie, Universitätsklinikum Heidelberg
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Thomas DFM: The acute scrotum. In: Thomas DFM, Duffy PG, Rickwood AMK, eds: London: Informa Healthcare UK 2008, 265–74. PubMed Central|
|2.||Beni-Isreal T, Goldman M, Bar Chaim S, Kozer E: Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med 2010; 28:786–789. CrossRef MEDLINE|
|3.||Sells H, Moretti KL, Burfield GD. Recurrent torsion after previous testicular fixation. ANZ J Surg 2002; 72:46–8. CrossRef MEDLINE|
|4.||Günther P, Rübben I: The acute scrotum in childhood and adolescence. Dtsch Artzebl Int 2012; 109(25): 449–58. VOLLTEXT|