29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

Aim

Acute scrotum is a common paediatric emergency. Most frequent causes are torsion of the testicular appendages (TA), torsion of the spermatic cord (TSC) and epididymoorchitis (EO). Common practice is to explore any case of tender scrotum based on history and clinical findings.  In the vast majority of cases a degree of reactive hydrocele is encountered at exploration regardless of cause. The aim of this work was to examine whether microbiology culture of the hyrocele fluid would modify postoperative management.

Methods

The case notes of all boys who underwent scrotal exploration for acute scrotum at a single institution between 2005 and 2009 were reviewed retrospectively and demographics, clinical assessment, intraoperative findings, fluid culture results, postoperative course and outcomes were recorded.

Main results

One hundred and eighty five boys of mean age of 9.1 years (range 6 months – 15 years) were identified. Exploration revealed TA in 104 boys, TSC in 26 and EO in 49; 6 boys had normal findings. One hundred and fifty seven boys in total had a fluid sample sent for microbiology culture and sensitivities intraoperatively. None of the patients had a pyocele at operation. Microbiology results were negative in all cases. Patients with EO received a course of antibiotics postoperatively.

Conclusions

Microbiology culture and sensitivities of the hydrocele fluid in cases of acute scrotum does not appear to have a role in postoperative management. However, it seems reasonable in patients with purulent fluid at scrotal exploration. Prompt diagnosis and surgical intervention remains the mainstay of management.

Aim

Acute scrotum is a common paediatric emergency. Most frequent causes are torsion of the testicular appendages (TA), torsion of the spermatic cord (TSC) and epididymoorchitis (EO). Common practice is to explore any case of tender scrotum based on history and clinical findings.  In the vast majority of cases a degree of reactive hydrocele is encountered at exploration regardless of cause. The aim of this work was to examine whether microbiology culture of the hyrocele fluid would modify postoperative management.

Methods

The case notes of all boys who underwent scrotal exploration for acute scrotum at a single institution between 2005 and 2009 were reviewed retrospectively and demographics, clinical assessment, intraoperative findings, fluid culture results, postoperative course and outcomes were recorded.

Main results

One hundred and eighty five boys of mean age of 9.1 years (range 6 months – 15 years) were identified. Exploration revealed TA in 104 boys, TSC in 26 and EO in 49; 6 boys had normal findings. One hundred and fifty seven boys in total had a fluid sample sent for microbiology culture and sensitivities intraoperatively. None of the patients had a pyocele at operation. Microbiology results were negative in all cases. Patients with EO received a course of antibiotics postoperatively.

Conclusions

Microbiology culture and sensitivities of the hydrocele fluid in cases of acute scrotum does not appear to have a role in postoperative management. However, it seems reasonable in patients with purulent fluid at scrotal exploration. Prompt diagnosis and surgical intervention remains the mainstay of management.