Scrotal swellings in the under 5s.

Abstract

SUMMARY Scrotal swelling is a common cause of referral to the paediatric surgical services in Edinburgh, constituting 12% of total admissions. Of these, 2818 (65%) were in boys under the age of 5 years, with a wide variety, including inguinal hernias, hydroceles, testicular torsion, tumours, and some interesting but uncommon conditions. A retrospective study was performed over a 12 year period to assess the incidence, aetiology, mode of presentation, disease, and management of scrotal swellings in boys under 5. Although most of the causes of these swellings were easily elucidated from a history and clinical examination, it was apparent that a high level of suspicion was also necessary to ensure that more serious problems did not go undetected.This paper studies the incidence, aetiology, disease, mode of presentation, and management of scrotal swellings presenting over a 12 year period in boys under the age of 5 years.A total of 37 001 patients were admitted to the paediatric surgical wards in Edinburgh (Royal Hospital for Sick Children, Western General Hospital, and Leith Hospital) over this period. Of these, 4341 were due to scrotal swelling, and 2818 of the scrotal swellings were in boys under 5.The case notes of these patients admitted due to scrotal swelling were examined and assessed by the author and the findings presented. FindingsInguinal hernia. A total of 2031 inguinal hernias were seen in boys under 5 during the 12 years. These constituted 60% of the total inguinal hernias seen. There was, incidentally, an overall boy:girl ratio of 4:1 in the paediatric age group over this period also. Details of these hernias are given in Table 1.Hydroceles. A total of 753 hydroceles in the under 5s were operated on during this period (86% of the total hydroceles seen). Of these, 507 (67%) were right sided, 185 (25%) left sided, and 61 (8%) bilateral.Testicular torsion. Altogether, 25 cases of testicular torsion (or torsion of testicular appendages) were seen within the age group of this study (56% of the total seen). Details of these are given in Table 2.

Inguinal Hernias Represent the Most Frequent Surgical Complication after Kasai in Biliary Atresia Infants

“…Based on open processus vaginalis, indirect IH is known as the most common indication for surgery in the first months of life [ 18 , 19 ]. While the incidence of IH in full-term neonates was estimated 1–5% [ 20 – 22 ], the first study of hernias in BA patients demonstrated an increased incidence of IH (8.1%) [ 11 ], which is corroborated by our findings revealing even a higher incidence of IH (19.6% in our BA patients). Therefore, we could confirm that BA patients suffer from a high risk for the development of IH.…”

“…Male gender is a well-recognized risk factor for IH development in healthy children [ 19 ]. While Wilson-Storey described an overall boy : girl ratio of 4 : 1, Powell et al found a more than 9-fold increased relative risk for IH in boys compared to female neonates [ 18 , 22 ]. In BA patients, Zani and Davenport observed a higher proportion of boys in hernia patients compared to nonhernia patients [ 11 ].…”

Clinical features of testicular torsion and epididymo-orchitis in infants younger than 3 months

“…The explanation for this is the rare occurrence of acute scrotum in neonates and young infants [6,7]. As hydrocele and inguinal hernia account for most acute or chronic scrotal swelling [8], it is not difficult for physicians to recognize hydrocele and inguinal hernia. Instead, it is confusing and difficult for physicians to diagnose acute scrotum resulting from other causes, such as TT and epididymo-orchitis (EO) in neonates and young infants.…”

Ovary and Testicle and Everything in Between: Lesions and Imaging in the Newborn

“…The most common diagnoses at surgery for acute scrotal symptoms, often referred to as "acute scrotum," in the first year of life are testicular torsion and torsion of the testicular or epididymal 178 http://dx.doi.org/10.1053/j.sult.2015.01.008 appendages. [9][10][11] The remainder of the differential diagnoses for "acute scrotum" in this age group include hematocele, scrotal hematoma, meconium peritonitis, meconium pseudocyst, idiopathic scrotal edema, orchitis, epididymitis, and abscess. Additional palpable abnormalities include benign and malignant lesions, as well as splenic or adrenal rests.…”