ÖZETAkut skrotum, inguinoscrotal bölgede ani başlayan kızarıklık, şişlik ve ağrı ile kendini belli eden yenidoğan dönemi ve adolesan dönemi başta olmak üzere her yaş-ta görülebilen çocuklardaki en önemli acil durumlardan biridir. İnguinal kanal ve skrotumda inflamasyon ve tü-möral şişliklerin yer aldığı tüm patolojilerle ayırıcı tanısı yapılmalıdır. Tanıda gecikme veya yanlış tanı konulması, özellikle spermatik kordun torsiyonuna bağlı testiste kalıcı iskemik hasar ve nekrozlara sebep olur. Potansiyel testis kaybı ihtimalinden dolayı akut skrotum düşünülen bütün vakalarda testis torsiyonu daima tanıda akla getirilmelidir. Akut skrotum olgularında özellikle spermatik kord torsiyonu sonrası iskemik nekroz ve testis kaybı sözkonusu olduğundan ayırıcı tanının önemi ve erken cerrahi müdahaleye dikkat çekmek amaçlanmıştır.Anahtar Kelimeler: Erkek çocuk, testis torsiyonu, akut skrotal şişlik, akut scrotum An Important Emergency Pathology in The Pediatric Urology: Akut Scrotum. ABSTRACTAcute scrotum may be seen at any age in boys, especially increases in newborns and adolescenses. The differential diagnosis should be done with inguinal canal pathologies like inflamatory conditions and mass in acute scrotum. A delayed or wrong diagnosis may lead to irreversible damage and ischemic necrosis of the testicle especially due to torsion of the spermatic cord. Due to the potential testicular loss, torsion of spermatic cord must be considered at differential diagnosis of acute scrotum.The purpose ofthis article is to attract attention, in order toreduce the loss of testes inpatients withacutescrotum,especially in spermatic cord torsionand testicularischemic necrosis with early surgicalintervention.

OBJECTIVE:A group of diseases in the scrotum setting forth by the sudden swelling and redness and pain consist of acute scrotal pathologies. The most common causes of acute scrotum in children are epididymitis, epididymo-orchitis, orchitis, testicular torsion, torsion of the appendix testis, incarcerated inguinal hernia and traumatic hydro/hematocele. In this study; we aim to evaulate patients with acute scrotal pathologies who were interned in our department.METHODS:All hospital data of cases who were interned at our deparment due to acute scrotum in between June 2010-June 2014 were evaluated retrospectively. Cases with incarcerated inguinal herni were excluded in this study.RESULTS:In a 4-year-period 114 cases were interned in our department with acute scrotum. Mean age of the patients was 7.6±4.577 years (min: 1m-max: 18yrs). Doppler US was performed in 112 patients to evaluate the blood flow while in 2 patients applied after normal office hours were evaluated without Doppler US and operated under emergency conditions. The patients had received diagnosis of epididymitis/epididymo-orchitis/orchitis (n=83 cases; 72.8%), testicular torsion (n=24; 21.1%), torsion of the appendix testis (n=2; 1.8%) with and traumatic hydrocele/ hematocele (n=5; 4.4%). While detorsion was performed in 18 (75%) cases with testicular torsion and orchiectomy in 6 (25%) cases. Histopathological evaluation of orchiectomy specimens revealed hemorrhagic necrosis and hemorrhagic infarction or ischemic changes. Normal testicular size and vascularity were detected in 11 (61.1%) cases with detorsioned testis as detected by follow-up Doppler US. Late orchiectomy was performed in 7 cases (38.9%) with complete atrophy due to lack of blood supply.CONCLUSION:Although Doppler US is very helpful for differential diagnosis of patients with acute scrotum who applied early period, if Doppler US will lead to a waste of time, direct surgery without delay will reduce the risk of testicular loss.