الفهرس 
Introduction
EmbryologyOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
The incidence of testicular torsion is about 1 in 4000 males 16 caused by congenital anomaly of the processus vaginalis called clapper-bell deformity. It occurs in the absence of precipitating factors in most cases[1] but some factors may predispose patients to torsion including age (peripubertal), testicular tumors, cryptorchidism and the horizontal lie of the testicle[2]The extravaginal torsion occurs exclusively in newborns when the testis and gubernaculum can rotate freely.
Primary inguinal hernia occurs in 1 to 5 percent of all newborns and 9 to 11 percent of those born prematurely [4]. Inguinal hernia repair is the most commonly performed surgical procedure in children The incidence in boys is three to four times higher than in girls, with the right side being affected more commonly in both sexes [7,8]. In boys, the incidence is highest during the first year of life and peaks during the first month [8, 9,10]. The right-sided preponderance is related to the later descent of the right testicle and later obliteration of the processus vaginalis. The incidence of bilateral hernias is approximately 10 percent in full-term and nearly 50 percent in premature and low-birth-weight infants [11-12].
The incidence of incarceration ranges from 14 to 31 percent, usually occurring in infants younger than one year of age Among children with incarcerated inguinal hernias, as many as 85 percent occur before the first birthday [13,13]. Incarceration is the presenting sign of the hernia in as many as 65 percent of cases [15]. It occurs more frequently in right-sided hernias as compared with left-sided ones (17 versus 7 percent) [7,16].
Inguinal hernias are more common in children with abdominal wall defects (e.g., Eagle-Barrett [prune belly] syndrome), conditions that increase intraabdominal pressure (e.g., continuous ambulatory peritoneal dialysis, ventriculoperitoneal shunts, ascites, chronic respiratory disease), connective tissue disease (eg, Ehlers-Danlos syndrome), abnormalities of the genitourinary system (eg, ambiguous genitalia, hypospadias, bladder exstrophy, cryptorchid testis), or a family history of inguinal hernia [7,18].
Aim of the work:
1- Describe and distinguish, the conditions that may produce acute scrotal pain in children through (the history, physical examination and laboratory testing)as testicular torsion, torsion of testicular appendices, epididymitis, scrotal trauma and hernia.
2- Appropriately order imaging studies to make the diagnosis of the acute scrotum.
3- Determine which acute scrotal conditions require emergent surgery and which may be handled less emergently or electively
The medical records of 30 boys under 18 years of age treated for acute scrotum at Assiut university hospital in three years (2012–2014) were reviewed. During the period studied all patients with acute scrotum that underwent surgical exploration of the scrotum & conservative treatment have been studied. The duration and characteristics of the symptoms, clinical findings prior to operation, the age of the patients and the operative findings were reported. The operative diagnoses were interpreted with focusing on the testicular torsion and the resulting gangrene of the involved testicle.
Results show that Scrotal explorations of 25 cases revealed 11 cases (44%) of spermatic cord torsion, 10cases (40%) of incarcerated inguinal hernias, 1case (4%) of epididymitis and 3 (12%) other conditions. In two cases of spermatic cord torsion the testicle was gangrenous and underwent hemiorchidectomy. In this study the salvage rate was 82% and all patients who were explored after 24 h had gangrenous testicles (Fig. 2). The main cause for this result was the delayed presentation to the hospital to seek for the proper management. The other cause was the mismanagement of two patients who lost their torsed testicles
Eleven patients of those who had been explored were found to have spermatic cord torsion, two patients had unfortunately gangrenous testicles and underwent hemiorchidoectomy and orchidopexy for the remaining testicle. All patients presented befor24 h from the onset of symptoms, except for two presented delayed or mismanaged as epidydimitis. The other nine cases with viable testicles had presented within 24 h of the onset of their pain; six patients had presented within less than 6 h and were managed by bilateral orchidopexy. Regarding their age, two boys were less than 1 year, twelve were between 1 and 5 years, ten were between 5 and 10 years, five were between 10 and 15 years and one patient was above 15 years old. The patients who underwent orchectomies are followed in the outpatient clinic with no complaints
Testicular torsion is a treatable emergency but might lead to testicular loss and impaired fertility. That risk necessitates the immediate management of the acute scrotum, considering the early exploration the best treatment to conserve the testicle